What are the rehabilitation options for Multiple Sclerosis (MS)?

From the Guidelines

Multiple sclerosis rehabilitation should prioritize a comprehensive approach combining physical therapy, occupational therapy, speech therapy, and psychological support to improve function and quality of life, with a focus on personalized programs adjusted to each patient's specific symptoms and disease course, as supported by the most recent evidence 1.

Introduction to Rehabilitation Options

The primary goal of multiple sclerosis (MS) rehabilitation is to maintain independence and manage symptoms like fatigue, weakness, balance issues, and cognitive changes.

Components of Rehabilitation

Rehabilitation typically includes:

• Physical therapy: strength training exercises, stretching routines, and balance exercises
• Occupational therapy: energy conservation techniques and adaptive equipment use
• Speech therapy: addressing communication and swallowing difficulties when present
• Cognitive rehabilitation: structured exercises for memory and processing speed challenges
• Psychological support: addressing mental health and promoting overall well-being

Personalized Approach

Rehabilitation programs should be personalized to each patient's specific symptoms and disease course, with adjustments made as the condition changes 1. Early intervention is crucial, as rehabilitation can help preserve function even as the disease progresses by promoting neuroplasticity.

Evidence-Based Recommendations

While the provided evidence primarily focuses on systemic lupus erythematosus (SLE) and systemic sclerosis (SSc), the principles of comprehensive rehabilitation and personalized approaches can be applied to MS management. Aerobic exercise, for instance, has been shown to increase aerobic capacity and reduce fatigue and depressive symptoms in patients with SLE 1, which could be beneficial for MS patients as well.

Key Considerations

• Patient education and self-management support are crucial for improving hand function, mouth-related outcomes, HRQoL, and ability to perform daily activities 1.
• Psychological interventions, such as cognitive behavioral therapy (CBT) and psychoeducational programs, can improve HRQoL, anxiety, and depressive symptoms 1.
• Individualized rehabilitation programs can improve hand mobility and HRQoL, while psychoeducational group programs can ameliorate feelings of helplessness 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Rehabilitation Options for Multiple Sclerosis (MS)

Rehabilitation programs are crucial for preserving physical, physiological, social, and professional functioning and improving quality of life in patients with MS 2. The main rehabilitation options for MS include:

• Physical rehabilitation methods, such as balance and gait therapy, speech and respiration rehabilitation, and occupational therapy 3
• Exercise-based therapies, which have shown benefits in improving MS-related physical symptoms, reducing the risk of developing cardiovascular disease, and improving cognitive function 3
• Cognition rehabilitation therapy, which focuses on behavioural tasks and is divided into two main forms: compensatory rehabilitation and restorative rehabilitation 3
• Excitation therapies, including cranial stimulation and other stimulation rehabilitation methods such as focal muscle vibration therapy 3
• Robot-assisted gait therapy and telerehabilitation, which are expected to play prominent roles in the future of rehabilitation therapy 3

Multidisciplinary Rehabilitation Approach

A multidisciplinary rehabilitative approach is recommended for patients with MS, as it can produce short-term gains at the levels of activity and participation 4. This approach includes:

• Inpatient multidisciplinary rehabilitation, which can improve activity and participation in patients with MS 4
• Outpatient and home-based rehabilitation programs, which can improve symptoms and disability in patients with MS 4
• Regular evaluation and assessment of patients for rehabilitation, to manage changing symptoms and ensure continuity of care 4

Therapies for Mobility Disability

Mobility disability is a common consequence of MS, and various therapies can help improve walking function, including:

• Symptomatic pharmacologic agents, such as dalfampridine, which can improve walking in patients with MS 5
• Non-pharmacologic therapies, such as exercise training, physical therapy, and gait training, which can improve walking in patients with MS 5
• Combinatory treatment approaches, which involve multiple intervention modalities and may be the most effective way to improve walking in patients with MS 5

Post-Relapse Rehabilitation Interventions

Multidisciplinary rehabilitation interventions can be effective in improving impairment or disability in patients with MS who have experienced a relapse 6. These interventions typically include a combination of physical, occupational, and speech therapies, and may be provided in an inpatient or outpatient setting 6. Further research is needed to better understand the rehabilitation needs of patients with MS after relapse and to improve research and care 6.