Rehabilitation Therapies in Multiple Sclerosis

You deserve to live well with MS

Undergoing Rehabilitation in MS
Undergoing Rehabilitation in MS. Caiaimage/Trevor Adeline

Experts believe that up to 58 percent of MS relapses cause some residual disability, meaning a person's neurological function does not go back to what it was before the relapse.

While this may be disheartening to hear, the upside is that there are effective, engaging strategies to minimize the impact of MS-related disabilities. These strategies are called rehabilitation therapies and include:

  • Physical therapy
  • Occupational therapy
  • Speech and swallow therapy
  • Cognitive rehabilitation

Physical Therapy

Within 10 to 15 years of multiple sclerosis onset, about 80 percent of people will experience walking problems, according to the National MS Society. While this may seem alarming, the good news is that physical therapy can help you improve your mobility and independence.

A physical therapist can teach you exercises to reduce muscle pain, spasticity, and weakness, and improve your balance and coordination. This may delay the need for a mobility device and help prevent falls, something that can put you five steps back in your MS care.

Also, if you are in need of a mobility device (or not sure if you are using the right one), a physical therapist can help you or your loved one find the right one. Examples of mobility devices include single-point or quad canes, motorized scooters, rolling walkers, and manual or power wheelchairs.

You may also be surprised to learn that in addition to muscle and mobility problems, MS fatigue can be improved with physical therapy, and there is science to back it up.

In one 2013 study published in NeuroRehabilitation, over 200 people with MS underwent physical therapy over a period of three months.

Of those who could ambulate (their sessions were focused on walk training and endurance), there was a significant improvement in their fatigue. This study highlights the importance of exercise for fatigue, which may seem paradoxical to you, but it's true. That being said, exercising with MS does require a delicate balance. You don't want to overexert or overheat yourself. This is why designing an exercise regimen with a physical therapist who works with people with MS is best.

Occupational Therapy

An occupational therapist can work with you or your loved one to maximize functioning at home and/or the workplace. For example, if your fatigue limits your ability to perform grocery shopping, your occupational therapist may suggest using a scooter when shopping or while walking when at home.

In addition to energy conservation, occupational therapists may suggest changes in your home to prevent falls and ease your comfort in performing activities of daily living.

These may include:

  • 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 a person on how to dress, bathe, and prepare meals based on MS-related disabilities

Also, some occupational therapists focus on cognitive rehabilitation (helping you improving thinking, memory, reasoning, and concentration) and vocational rehabilitation (assessing job readiness and ways to maintain or find jobs that meet your needs).

Speech and Swallow Therapy

As MS progresses, there is an increased risk for developing problems with swallowing, speaking, and taking deep breaths. Often times, these problems coincide, as similar muscles are used to control these functions.

To improve breathing techniques, speech and swallow therapists often work with pulmonary doctors (lung specialists). Strategies may include techniques to clear mucous from the throat, exercises to ease breathing, and medical therapies like nebulizers or oxygen in some people.

When a person with MS develops difficulty swallowing foods and liquids, there are major concerns including dehydration, poor nutrition, choking, and aspirating (when food contents go into the lungs). A speech and swallow therapist may recommend eating techniques that will maximize nutritional intake while minimizing the risk of aspiration. These techniques often include:

  • resting before eating
  • sitting in an upright position
  • keeping your chin parallel to the table
  • performing double swallows.

Finally, speech problems are common in MS, affecting up to 40 percent at some point, according to the National MS Society. These problems may include difficulties with articulation (i.e., slurred speech), slowed speech, soft speech, or impaired voice quality (e.g., hoarseness).

The good news is that a speech therapist can help reduce these problems by teaching mouth-strengthening exercises. A speech therapist may also recommend communication devices like voice amplifiers so you can be heard better.

Cognitive Rehabilitation

Problems with thinking, memory, attention, speed of information processing, organizing, reasoning, and/or visual-spatial abilities are common in MS. Cognitive problems usually come on gradually and can occur at any time during the disease course. For some people, they are even the first symptom of MS.

The good news about cognitive function in MS is that it's rarely ever severely impaired. Regardless, though, even with mild cognitive deficits, you or your loved one may feel isolated or anxious about engaging with others at home or at work.

Some people with MS who have cognitive dysfunction choose to be evaluated by a neuropsychologist, especially if their cognitive mishaps are affecting how they function in their daily lives.  Although cognitive testing can be time consuming (requiring a number of standardized tests) and expensive, it can help you or your loved one develop a clear picture of how MS has affected your cognition—or if there is another health concern going on, like depression or MS-related pain, which can worsen cognition.

In addition, if you get evaluated more than once, your neuropsychologist can compare your recent cognitive test results to prior years to determine whether your cognition has worsened, stayed the same, or even improved.

While there is no medication for MS-related cognitive problems, you can undergo cognitive rehabilitation which allows you to compensate for your cognitive problems. Examples may include:

  • planning your most brain-intense activities for the part of day when you are most alert
  • how to use electronic devices or good old fashioned 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 (this can improve your brain's resiliency to MS-related damage)

Stress management, psychotherapy, and aerobic exercise are also commonly part of cognitive rehabilitation. These strategies combined can help you feel self-assured again and not limited in social, family, or work endeavors.

A Word from Verywell

Rehabilitation therapies play a paramount role in your MS health. But they are not a quick fix. With these therapies, it takes time and patience to see results. You will experience obstacles and some frustrations along the way but it's worth it—for your MS and for your well-being.

It's also important to note that it's okay to switch therapists or therapy sites if you are not content with your current one. Getting a second opinion is never a bad idea, and sometimes it takes time to find that right healing, trusting relationship.  


Asano M, Raszewski R, Finalyson M. Rehabilitation interventions for the management of multiple sclerosis relapse: A short scoping review. Int J MS Care. 2014 Summer;16(2):99-104.

Beer S, Khan F, Kesselring J. Rehabilitation interventions in mutiple sclerosis: an overview. J Neurol. 2012 Sep;259(9):1994-2008.

Brichetto G, Rinaldi S, Spallarossa P, Battaglia MA, & deCarvalho ML. Efficacy of physical therapy in multiple sclerosis as measured with the modified fatigue impact scale and ambulation index: a retrospective study. NeuroRehabilitation. 2013;33(1):107-12

Finlayson, M. National MS Society: Occupational Therapy in Multiple Sclerosis Rehabilitation.

Nabavi SM, Sangelaji B. Cognitive dysfunction in multiple sclerosis: Usually forgotten in the clinical assessment of MS patients. J Res Med Sci. 2015 May;20(5):533-34.

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