Multiple Sclerosis Health Center

When you have multiple sclerosis (MS), you may have certain physical and cognitive challenges. Rehabilitation-including physical therapy, occupational therapy, speech therapy, and cognitive retraining-may help reduce these disabilities.

Key points

• Physical therapy may improve your ability to perform daily activities and make you feel better.
• Occupational therapy may help you perform daily activities more easily-especially those involving your hands and arms, such as grooming, dressing, and eating. Assistive devices may be used to help you perform daily tasks.
• Speech therapy may improve your communication skills if MS symptoms are making speaking difficult.
• Cognitive retraining may help improve cognitive impairment caused by MS.

Your rehabilitation (rehab) program will depend upon your specific needs based on the type of MS that you have and how it has impacted your daily living. You do not need to be severely disabled to enjoy the benefits of rehab. Your rehab may include a combination of the following therapies or only one, depending on your personal needs.

Physical therapy

Relapsing-remitting MS, the most common type of MS, may cause a variety of physical problems at different times. Your physical therapy program will reflect the kinds of exercises you are able to do at any given time.

Physical therapy will usually consist of alternating exercise with periods of rest for the best results. Depending on your ability, exercise usually includes gentle aerobic exercise (such as walking) and aquatics-exercising in water-which reduces the effects that gravity has on your muscles and joints. You should be able to obtain a greater range of motion in the water.

Occupational therapy

Your need for occupational therapy will depend on your personal symptoms and disability from MS. Occupational therapy may help with activities such as getting dressed, brushing your teeth, grooming, eating, cooking, cleaning your house, or any other task that you are having difficulty completing.

An occupational therapist will assess your living environment to see whether you need assistive devices such as a cane to help you walk, hooks to help you button your clothes, an electric toothbrush, or a wheelchair.

The occupational therapist may help the physical therapist recommend strengthening and stretching exercises and other activities that will help you the most.

Speech therapy

Speech therapy may be part of your rehab if weak facial muscles or lesions (injured tissue from demyelination) in the brain have affected your ability to talk or swallow.

Your normal speech rhythm may be interrupted by long pauses between words or syllables. You may also begin to slur your words or have a nasal tone when you speak. Speech therapy may help strengthen the muscles in your tongue, cheeks, mouth, and lips, which may reduce these symptoms.

If you have difficulty swallowing, a speech therapist may recommend strengthening exercises and help you identify foods that are easier to swallow.

Cognitive retraining

Many people with MS develop some kind of cognitive impairment-usually slowed thinking, reasoning, remembering, or concentrating-from demyelination and the interruption to the flow of messages to and from the brain. But only a small number of people have resulting cognitive problems severe enough to interfere with daily activities. For these people, cognitive retraining may help reduce cognitive disability.

Cognitive retraining offers ways to reduce the effects of cognitive disability. For instance, you may become better organized by retraining yourself to rely on a notebook, computer, cell phone, or filing system to help you store and recall information.

Rehabilitation (rehab) may help you live a more productive life, especially if your symptoms are constant or severe. Physical and occupational therapies may help keep you mobile, speech therapy may help you continue to communicate well, and cognitive retraining may help with memory and organization. All types of rehab will be tailored to fit your specific needs.

A primary goal of physical therapy is to help prevent physical complications that may occur with MS such as contractures (abnormal shortening of muscles) or pressure sores (bedsores) if you are immobile.

Physical therapy

Your personal physical therapy program to restore and maintain mobility will depend on the severity and duration of your MS symptoms. You may need physical therapy only occasionally as symptoms flare. Or you may need it daily to reduce constant symptoms.

Your ability to perform the exercises will help your therapist know which exercises to prescribe. Most therapy can be done at home either alone or with an assistant after an initial training program at the therapist's office. Occasional office visits will be needed to help the therapist monitor your progress. All exercise programs should allow you time to "cool off" in between exercises, since heat can make MS symptoms worse. The most common types of physical therapy include:

• Exercises to stretch your muscles and increase your range of motion.
• Exercises to strengthen and develop upper arm muscles and upper body control.
• Gentle aerobic exercise, such as walking or riding a stationary bike.
• Aquatic (water) exercises.
• Instructions on how to fall safely if you have problems with balance.

Occupational therapy

Occupational therapy usually first includes an assessment to find out your needs and to see whether assistive devices are needed. The occupational therapist will provide you with:

• Help in getting appropriate assistive devices, including those that help you stay mobile.
• Training in walking and use of assistive devices, including use and care of a wheelchair.
• Instructions on how to transfer from a wheelchair to a bed, bathtub, or automobile if needed.

Speech therapy

MS can cause problems in speech, speech patterns, and with swallowing when lesions form in the brain and interfere with message flow in the nerves. Speech therapy may help you:

• Reduce long pauses in your sentences or within words.
• Reduce slurring of words, which may result from weakening or uncoordinated muscles of the tongue, lips, cheeks, and mouth.
• Reduce nasal sound that may occur when facial muscles become too relaxed.
• Help improve speech patterns or rhythms, enunciation of words, and general oral communication.
• Help you speak with other means-such as alphabet cards, a cell phone, or tapes-if you are no longer able to speak.
• Help you to recognize swallowing problems and change the types of food you eat if swallowing becomes difficult.

Cognitive retraining

Cognitive retraining is a fairly new area of MS rehab. Its goal is to help you improve cognitive function if you have any cognitive impairment, such as difficulty remembering, caused by MS. Cognitive retraining may help you:

• Evaluate and identify any cognitive impairment related to MS.
• Retrain yourself to rely on other methods for remembering and staying organized, such as with a computer, cell phone, notebook, or filing system.
• Help you identify and get help for associated depression, anxiety, stress and fatigue, all of which may reduce your cognitive ability.

For more information about rehabilitation and MS, talk to:

• Your doctor.
• A physical therapist.
• An occupational therapist.