Therapy is a critical element of your MS care plan
Medically reviewed by Brigid Dwyer, MD
Along with the medications that treat multiple sclerosis (MS), rehabilitation is a key part of managing your condition effectively, particularly after a relapse. Depending on your symptoms, you may only occasionally need rehabilitation or you may require these therapies regularly to help you stay as healthy as possible.
From physical therapy to speech-language therapy to cognitive therapy (and more), there are a number of effective, engaging rehabilitation options that can minimize the impact of MS-related disabilities and help you function at your best in every aspect of your life.
Video: “Rehabilitation of the patients with Multiple Sclerosis”
MULTIPLE SCLEROSIS. EXERCISES FOR STRETCHING AND IMPROVING BODY FLEXIBILITY AND JOINT MOBILITY, REDUCING TONE
For additional information about Rehabilitation of the patients with Multiple Sclerosis you can watch a video demonstrating exercises and rehabilitation recommendations.
Physical Therapy
Physical therapy can help treat a number of MS-related symptoms and needs.
Mobility and Muscle Problems
Walking problems are extremely common in MS and may be one of the first symptoms you experience. Physical therapy can help you improve your mobility and independence.
A physical therapist can teach you exercises to reduce muscle pain, spasticity, and weakness, as well as help you improve your balance, coordination, strength, and flexibility. This may delay your need for a mobility device and help prevent falls, something that can put you five steps back in your MS care.
If you do need a mobility device (or you’re not sure if you’re using the right one), a physical therapist can help you find what’s best for you. Examples of mobility devices include single-point or quad canes, motorized scooters, rolling walkers, and manual or power wheelchairs.
MULTIPLE SCLEROSIS. EXERCISES TO STRENGTHEN THE MUSCULOSKELETAL AND MUSCULAR SYSTEM, ENDURANCE
Fatigue
You may also be surprised to learn that, in addition to muscle and mobility problems, physical therapy exercises can improve MS-related fatigue. Treating fatigue is pretty crucial since it affects between 75 percent and 95 percent of patients, and 50 percent to 60 percent report that it’s one of the most difficult MS symptoms to deal with.
One of the reasons that exercise helps is that being inactive actually contributes to fatigue by causing your body to work harder to do everything because it’s out of shape. Exercise can also combat stress, help you sleep better, and improve your mood—all factors that can affect your fatigue level.
A 2019 Cochrane overview of Cochrane reviews on rehabilitation therapies for people with MS determined that physical therapies such as exercise and physical activity may not only improve functions such as strength, mobility, and lung capacity, they can also reduce fatigue and improve your overall quality of life.
Exercising with MS requires a delicate balance. You don’t want to overexert or overheat yourself, so designing an exercise regimen with a physical therapist who works with people who have MS is your best bet.
MULTIPLE SCLEROSIS. EXERCISES TO IMPROVE COORDINATION, BALANCE AND GAIT
Posture and Positioning
A physical therapist can teach you how to maintain good posture and body positioning, which may alleviate some of your MS-related pain. If you’re in a wheelchair or you have limited mobility, proper positioning can also prevent pressure sores.
MULTIPLE SCLEROSIS. STRETCHING AND WORKING WITH A MASSAGE ROLLER. ADVANCED STAGE OF REHABILITATION
Occupational Therapy
Occupational therapy helps you maximize your daily functioning at home and/or in the workplace.
Energy Management
An occupational therapist can work with you on ways to conserve your energy. For example, if your fatigue limits your ability to go grocery shopping, your occupational therapist may suggest using a scooter when running errands.
Skills and Devices for Daily Activities
Occupational therapists may recommend changes in your home to prevent falls and ease your comfort in performing activities of daily living, such as:
- Getting rid of loose rugs to prevent falls
- Installing handrails in the bathroom to maximize safety and accessibility
- Adjusting lighting to address vision problems
- Teaching you and/or loved ones how to evaluate and maintain the safety of mobility devices
- Providing tips on hiring and working with a caregiver
- Instructing you on how to dress, bathe, and prepare meals based on MS-related disabilities
- Giving you exercises that strengthen your hands and arms and improve your coordination
- Determining what adaptations you may need to keep driving
- Assessing what sort of devices or adaptations you need to use a computer and other electronic equipment
Some occupational therapists also focus on cognitive rehabilitation and vocational rehabilitation (see below).
Speech-Language Therapy
As MS progresses, you’re at an increased risk for developing problems with swallowing, speaking, and taking deep breaths. Often, these problems coincide because similar muscles are used to control all of these functions.
A speech-language pathologist can help you tackle these difficulties with specific strategies.
APHASIA. DYSARTHRIA. SET №1:TONGUE EXERCISES
For additional information about the rehabilitation of the patients with Aphasia, Dysarthria you can watch a video demonstrating exercises and rehabilitation recommendations.
Improve Breathing
To improve breathing capabilities, speech-language pathologists may work with pulmonologists (lung specialists). Strategies a speech-language pathologist may use include:
- Techniques to clear mucus from your throat
- Exercises to help you breathe more easily
- Medical therapies like nebulizers or oxygen
APHASIA. DYSARTHRIA. SET №2:LIP EXERCISES
Minimize Aspiration
When a person with MS develops difficulty swallowing foods and liquids, this causes major concerns, including dehydration, poor nutrition, choking, and aspiration (when you breathe food or drink into your lungs).
A speech-language pathologist may recommend eating techniques that will maximize your nutritional intake while minimizing your risk of aspiration. These approaches often include:
- Resting before eating
- Sitting in an upright position
- Keeping your chin parallel to the table
- Performing double swallows
APHASIA. DYSARTHRIA. SET №3: CHEEK EXERCISES
Reduce Speech Difficulties
Speech problems are common in MS, affecting up to 40 percent of patients at some point. These problems may include difficulties with articulation (slurred speech), slowed speech, soft speech, or impaired voice quality like hoarseness, breathiness, or a nasally speaking voice.
A speech-language pathologist can help reduce these speech difficulties by teaching you mouth-strengthening exercises. He or she may also recommend communication devices like voice amplifiers so you can be heard better.
Some speech-language pathologists also do cognitive evaluations and cognitive rehabilitation (see below).
APHASIA. DYSARTHRIA. SET №4: JAW AND PALATE EXERCISES
Cognitive Rehabilitation
Cognitive problems affect an estimated 34 percent to 65 percent of MS patients. They usually come on gradually and can occur at any time during the disease course. For some people, they’re even the first symptom of MS.
Possibilities include issues with:
- Thinking
- Memory
- Attention
- Speed of information processing
- Organizing
- Reasoning and problem solving
- Visual-spatial abilities
- Verbal fluency
While there’s no medication for such problems in MS, cognitive rehabilitation may help. It’s performed by a qualified neuropsychologist, occupational therapist, or speech-language pathologist and helps you learn to compensate for your cognitive concerns and improve your overall function.
The good news about cognitive function in MS is that it’s rarely ever severely impaired. Regardless, even with mild cognitive deficits, you may feel isolated or anxious about engaging with others at home or at work.
APHASIA. DYSARTHRIA. SET №5: RESPIRATORY-VERBAL, ARTICULATORY EXERCISES
Cognitive Evaluation
The cognitive therapies you need hinge on your cognitive evaluation. Some people with MS who have cognitive dysfunction choose to be evaluated if their cognitive issues are affecting how they function in their daily lives.
Although cognitive testing can be time-consuming (it requires a number of standardized tests), it can help you develop a clear picture of how MS has affected your cognition or if there’s another health concern going on, like depression or MS-related pain, which can worsen cognition.
Seeking cognitive evaluations early in your disease and having follow-ups allows your provider to compare recent results to those of prior years, helping establish whether your cognition has worsened, stayed the same, or even improved.
Cognitive testing can be expensive. Some insurance plans will cover it, though, so it’s best to contact your carrier for more information.
Strategies
Based on your evaluation, your cognitive therapist may recommend one or more of the following, among other possibilities. The strategies you may use over time may also be changed.
- Planning your most brain-intense activities for the part of the day when you’re most alert
- Using electronic devices or simply a pen and paper to remember things
- Focusing on a single task at a time and learning how to block out potential distractions
- Engaging in brain-stimulating activities like reading or card games
- Engaging in pleasurable activities, which can improve your brain’s resiliency to MS-related damage
- Engaging in physical exercise, which has been shown in studies to help improve cognitive function
Stress management and psychotherapy may also be a part of cognitive rehabilitation, especially considering the fact that depression is so common in MS.
A 2017 review of studies on rehabilitation therapies in MS found moderate-quality evidence that cognitive-behavioral therapy (CBT), a type of psychotherapy, is beneficial for treating depression and helping patients accept and cope with MS. If you have symptoms of depression, be sure to talk to your healthcare provider about getting treatment.
Vocational Rehabilitation
Vocational rehabilitation specialists can train you to use assistive devices or make accommodations that adapt your current workplace to meet your needs, or help you find a new job that does. They also assess job readiness and perform job coaching and mobility training.
Some occupational therapists also do vocational rehabilitation since there’s quite a bit of overlap between the two disciplines.
Vocational rehabilitation programs may be available through your county or state. Contact either of these for more information.
Multidisciplinary Programs
Multidisciplinary rehabilitation programs involve a team of healthcare professionals from two or more specialties, such as medical, physical therapy, occupational therapy, speech-language therapy, cognitive rehabilitation, neurology, nursing, etc. These programs can be in-patient or out-patient.
The aforementioned 2019 Cochrane review found that a comprehensive multidisciplinary rehabilitation program improves function and disability and leads to longer-term improvement in the quality of life and activity. These findings suggest that utilizing all the rehabilitation therapies you need is a good way to maximize the potential benefits.
Summary
Rehabilitation therapies play a paramount role in your MS health, but they aren’t a quick fix—it takes time and patience to see results. You may experience obstacles and some frustrations along the way, but the overall benefits to your long-term health are worth it. Talk to your healthcare provider about which rehabilitation therapies are appropriate for your individual needs and when you might need them.
Keep in mind, too, that it’s OK to switch therapists or therapy sites if you’re not content with your current one. Getting a second opinion is never a bad idea, and sometimes it takes time to find the right healing, trusting relationship. Our Doctor Discussion Guide below can help you start that conversation.
By Colleen Doherty, MD
Dr. Doherty is a board-certified internist and writer living with multiple sclerosis. She is based in Chicago.
Check out the demo version of our sets of exercises for Multiple Sclerosis on YouTube
You can find more information about Multiple Sclerosis in our Blog.
Our website presents the following sets of exercises for the rehabilitation of the patients with Multiple Sclerosis:
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MULTIPLE SCLEROSIS. EXERCISES FOR STRETCHING AND IMPROVING BODY FLEXIBILITY AND JOINT MOBILITY, REDUCING TONE
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MULTIPLE SCLEROSIS. EXERCISES TO STRENGTHEN THE MUSCULOSKELETAL AND MUSCULAR SYSTEM, ENDURANCE
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MULTIPLE SCLEROSIS. EXERCISES TO IMPROVE COORDINATION, BALANCE AND GAIT
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MULTIPLE SCLEROSIS. STRETCHING AND WORKING WITH A MASSAGE ROLLER. ADVANCED STAGE OF REHABILITATION
CHECK OUT THE DEMO VERSION OF OUR EXERCISES FOR THE PATIENS WITH APHASIA and DYSARTHRIS ON YOUTUBE.
Our website presents the following sets of exercises for rehabilitation of the patients with Aphasia, Dysarthria:
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APHASIA. DYSARTHRIA. SET №1:TONGUE EXERCISES
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APHASIA. DYSARTHRIA. SET №2:LIP EXERCISES
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APHASIA. DYSARTHRIA. SET №3: CHEEK EXERCISES
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APHASIA. DYSARTHRIA. SET №4: JAW AND PALATE EXERCISES
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APHASIA. DYSARTHRIA. SET №5: RESPIRATORY-VERBAL, ARTICULATORY EXERCISES
Sources
https://www.verywellhealth.com/rehabilitation-therapies-for-ms-4072854
- Amatya B, Khan F, Galea M. Rehabilitation for People With Multiple Sclerosis: An Overview of Cochrane Reviews. Cochrane Database of Systematic Reviews. 2019;1:CD012732. doi:10.1002/14651858.CD012732.pub2.
- Khan F, Amatya B. Rehabilitation in Multiple Sclerosis: A Systematic Review of Systematic Reviews. Archives of Physical Medicine and Rehabilitation. 2017;98(2):353–367. doi:10.1016/j.apmr.2016.04.016.
- National Multiple Sclerosis Society. Fatigue: What You Should Know. Updated 2019. https://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Brochures/Brochure-Fatigue-What-You-Should-Know.pdf.
- National Multiple Sclerosis Society. Managing Cognitive Problems in MS. Published 2019. https://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Brochures/Brochure-Managing-Cognitive-Problems.pdf.
- National Multiple Sclerosis Society. Speech & Swallowing: The Basic Facts. Published 2014. https://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Brochures/Brochure-Speech-Swallowing-BasicFacts-FINAl.pdf.
FREQUENTLY ASKED QUESTIONS
1. What are usually the first signs of MS?
Early signs of MS include:
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- Bladder issues
- Bowel problems
- Difficulty focusing/concentrating
- Dizziness/lack of coordination
- Fatigue
- Muscle spasms
- Pain throughout the body
- Sexual problems
- Speech problems
- Tingling and numbness
- Vision problems
- Weakness
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2. What age does MS usually start?
People are typically diagnosed with MS between the ages of 20-40, though it can develop at any age. Late-onset MS can affect people aged 50 and older.
Learn More Multiple Sclerosis (MS): Prevalence and Incidence
3. What does MS do to a man?
Males with MS experience common symptoms such as issues with balance and mobility, pain, vision problems, numbness, and tingling. Research shows that some males with MS have higher rates of low testosterone ( hypogonadism), which may be associated with disease progression.17
4. Can you suddenly get MS?
MS generally starts with a vague symptom that goes away within a few days or weeks. Symptoms may appear suddenly and disappear after the first episode/attack. An attack is when MS symptoms suddenly show up. In order to be diagnosed with MS, you must have had two attacks at least one month apart.
5. What are the four stages of MS?
MS is a progressive disease, and most people with MS follow one of four identified disease courses, including:
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- Clinically isolated syndrome. The first episode of neurological symptoms is caused by demyelination and inflammation in the central nervous system.
- Relapsing-remitting. Clearly defined attacks of new and increasing neurologic symptoms. Attacks are often followed by remission (period of partial or complete recovery) before the next relapse/attack.
- Secondary progressive. People with this form of MS may experience relapses of attacks, followed by partial recovery, but the disease does not disappear between attack cycles.
- Primary progressive. Characterized by worsening neurological function and disability from the onset of symptoms, with no relapses or remission.
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Learn More What to Know About the Multiple Sclerosis Diagnostic Criteria
6. Is MS higher in men or women?
Females are two to three ties more likely to be diagnosed with MS than males. Sex hormones may play a role in why females develop the disease more often.
7. Does MS affect men differently than women?
Many MS symptoms are experienced by males and females alike, such as problems with balance and walking, vision problems, numbness/tingling, and bladder issues. Males have a higher risk of primary progressive MS and seem to have more neurodegeneration and worse cognitive symptoms (e.g., memory problems, difficulty focusing) than females.
8. What type of dysarthria is most common?
Mixed dysarthria is the most common type. It’s caused by damage to several regions of the nervous system, but particularly the upper or lower motor neurons.
9. Is dysarthria the same as dysphagia?
Dysphagia is trouble swallowing. A lot of conditions that lead to dysarthria can also cause dysphagia. For example, people who have had a stroke or a person with multiple sclerosis (MS) may develop dysphagia, dysarthria, or both.
