Rehabilitation

For many people with MS, pharmacological therapy alone is not able to address particular symptoms adequately or, in some cases, disease progression. Rehabilitation is a component of the comprehensive management of MS that focuses on function, and adds non-pharmacological strategies for the care of the person.

Rehabilitation in MS aims to encourage autonomy and improve the quality of life through goal-oriented programmes that involve the person with MS in deciding on treatment priorities. For example, an individual may want help moving around, remembering things better, or feeling less fatigued.

To ensure rehabilitation is most effective, it is important that all members of the team work together. The team should include the person with MS and their family, who work closely with experts from a number of specialised disciplines, including professionals knowledgeable in exercise, technical aids, speech and swallowing, vocational aspects and counselling.

Working in collaboration, the rehabilitation team aims to create a plan that meets the needs of the person with MS, taking into account his or her priorities, lifestyle and desires.

Some of the main disciplines are discussed below. More comprehensive information can be found in MS in focus – rehabilitation.

Physiotherapy

This type of rehabilitation is mainly used following a relapse or when a person finds they can no longer do certain tasks. For example, if a person has increased weakness in their legs, physiotherapy can help improve strength and control through resistance exercises. Spasticity and muscle stiffness can be relieved by stretches and positioning techniques taught by a physiotherapist.

Speech and swallowing therapy

Some people with MS may have problems with speech and swallowing, depending on where lesions occur in their central nervous system. A speech and swallowing therapist would undertake a thorough assessment of the lips, throat, tongue and larynx areas to identify the main issues. They then use strategies to help correct the problems, such as changing the head or body position, suggesting controls during swallowing or changing diet.

Occupational therapy

The type of therapy focusses on skills that are important for continuing the daily occupations of life, for example, washing, dressing, cooking, walking, writing, going to work or taking part in social or leisure activities. The occupational therapist will assess each individual and then work with them to help restore function, suggest other ways of doing things, or give advice on an aid or adaption that may help, for example grab rails in the bathroom.

Vocational rehabilitation

This rehabilitation provides services, support and training to enable people with MS to obtain, maintain and advance in their job. For example, therapists can work with someone to identify and help implement workplace changes that will help them stay in their job, such as changes to their working day or memory aids. They can also advice on their legal rights.

Counselling

Counselling for people with MS is not just about listening and giving advice, it can also help with the uncertainties and unpredictability of MS. Counselling also gives people with MS a chance to discuss the personal problems related to the disease with someone neutral.

These might include talking about family pressures brought about by MS and discussing strategies such as re-assigning household tasks. Getting a diagnosis of MS can be bewildering and a person may feel isolated and lonely; counselling can provide emotional support during this time.

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Thessaloniki, Greece, 10/2011. Aristidis Koutsoupias (left) visits Panagiota Tsinoni twice per week for personalised physiotherapy sessions. Now that Panagiota has lost feeling in her feet, they often focus on finding balance in the core of her body. For many people with MS, the decision to avoid going out to walk is less linked to their physical limitations than it is to the fear of falling or having a relapse in public. Credit: Maximiliano Braun. Published on this website by kind permission of the European Multiple Sclerosis Platform.

A physio is helping Little Gao once a day with his exercises. His family pays around 3000 Rmb (300 pounds) a month for this treatment alone. Reproduced with the kind permission of Li YouHao,© 2014 Li Yu Hao