If you're living with multiple sclerosis (MS), you may have to relearn how to do tasks you used to be able to accomplish easily, such as grooming, walking, or speaking clearly.
Consider signing up for different types of rehabilitative therapies, such as physical and occupational therapy, or cognitive rehabilitation, which can help you maintain existing nerve cells and build new connections between nerve cells. 

“All of us have neuron generative cells in our body. When we use a region of the brain, the connections between nerve cells become stronger,” says Thomas P. Leist, MD, PhD, the chief of the division of clinical neuroimmunology and director of the Comprehensive Multiple Sclerosis Center at Thomas Jefferson University in Philadelphia. Dr. Leist advocates rehabilitation with a view toward both improving your daily function and strengthening your neural networks, with the hope of protecting against the damage of MS.

Begin with a medical evaluation of how well you are managing the tasks of daily living. "We do the [Functional Independence Measure] test, which measures how much help a patient needs with daily tasks," says Connie Cushing, MS, inpatient physical therapy coordinator for Children's Hospital in Birmingham, Ala. "Broad categories include areas like grooming, dressing, walking, using stairs, getting in or out of [the] shower/tub, and cognitive issues, such as problem solving and memory." 

A specific rehabilitation plan for MS is based on an individual's needs as identified by these tests and observations, Cushing says. The goal of rehabilitation during MS treatment is to reduce disability and help patients continue to live as independently as possible with the abilities they have.

Physical Therapy

Research has shown that physical therapy and exercise can help people living with MS retain their mobility longer. A review of 18 studies of physiotherapy, including physical therapy, confirmed that these therapies may result in an improvement in balance, which is one measure of physical ability. 

A physical therapist (PT) can help an MS patient throughout the course of treatment. The PT might focus on an appropriate fitness program, home safety, posture, pain management, stretching, gait (walking) management, balance, and bladder retraining. A PT can also help you learn to use a cane, walker, scooter, and wheelchair.

Fatigue is a significant problem for the majority of people who have multiple sclerosis. For this reason, "in clinic, we also focus on problem-solving energy conservation, meaning [learning how to] pick and choose activities throughout the day if you are going through a period of pain or muscle weakness," Cushing says.

Just as people with MS may lose control over some of the muscles involved with motor movements, such as those involved with walking, they can lose control over muscles that control speech. Speech therapy can retrain specific muscle groups, which will help make speech clearer. As an additional benefit, this training may also address problems a person might be having with swallowing safely since swallowing involves many of the same muscles used for speaking.

Cognitive Rehabilitation

"[Cognitive impairments] are probably the biggest reason people with MS leave work," says Nicholas LaRocca, PhD, vice president of health care delivery and policy research for the National Multiple Sclerosis Society. Cognitive impairments associated with MS include loss of memory and recall, inability to organize time or complex tasks, and difficulty multitasking.

Cognitive rehabilitation helps people living with MS develop strategies that can minimize the effects of cognitive impairment, says LaRocca. Cognitive rehabilitation might include learning to use a PDA (personal digital assistant) to set reminders, or it might include training to manage more than one task at a time.

The bottom line: One or more of these rehabilitation options can be effective in reducing disability caused by multiple sclerosis, so talk with your doctor if rehab is not already part of your MS treatment plan.

You might also need to seek assistance for negotiating with your health insurance company to make sure you can get the services you need. Leist points out that a recent legal settlement with Medicare means some patients will be able to get physical therapy services to maintain their current level of ability rather than only qualifying for services if improvement is likely (a challenge for some MS patients). So don’t assume you don’t need or won’t qualify for rehabilitation services.