Rehabilitation therapy for multiple sclerosis (MS) encompasses physical rehabilitation with exercise regimens, physical therapy, medication or interventional strategies to manage symptoms, and cognitive rehabilitation leveraging in-person and virtual platforms. There is some evidence across studies that rehabilitation can have a modest benefit, but identifying the most effective rehabilitation modality and the optimal timing of therapy administration remains unclear.

Almost every patient asks me what they can do in their day-to-day life to help with their MS. They may ask about supplements and diet, and we often bring up rehabilitation. There is a misconception that rehabilitation is only for the most disabled patients or for those with physical disabilities. Nevertheless, we are making an effort to intervene earlier and to use both physical and cognitive rehabilitation to help patients with MS develop health maintenance strategies and take an active role in training their brain and muscles to serve them well in the long-term.

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With respect to physical rehabilitation, a customized exercise program early in the disease course might provide a benefit. However, there have been only limited studies on this, and it is difficult to study because there is no across-the-board, one-size-fits-all prescription. When we look across studies, there is some evidence that physical rehabilitation may have a modest benefit for MS. Physical rehabilitation might involve a patient working with a physical therapist and doing a home exercise program between physical therapy sessions.

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There are also augmentation strategies that may be useful in people who have functional deficits and are trying to get back some of their motor strength and coordination. These include medication, interventional procedures for spasticity management, transcranial magnetic stimulation, a robotic exoskeleton, or immersive virtual reality experiences. These ideas for augmenting rehabilitation are in need of further research and exploration.

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Cognitive rehabilitation is another intervention that holds a lot of interest, and there is a desire to explore and test whether it may benefit patients with MS. Researchers are evaluating cognitive rehabilitation through virtual and in-person platforms. However, we lack data to prove the efficacy of cognitive rehabilitation, and it falls under the category of something that might help and should not hurt patients.

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With respect to the timing of rehabilitation, I think that we should shift the paradigm from it being primarily for people with disabilities later in the disease course to it being something patients can do earlier in the disease course. However, we should be cautious about introducing rehabilitation too soon in patients newly diagnosed with MS, as it might be overwhelming while they are also thinking about which medications to start and are trying to accept their diagnosis. So, I would insert it shortly after making the diagnosis, setting the treatment plan as a way to show patients what they have control over and how they might potentially be able to help themselves. Whether I discuss formal rehabilitation therapy or more informal lifestyle changes depends on the patient.