Multiple Sclerosis

1. What Is Multiple Sclerosis?

Multiple sclerosis (MS) is a chronic autoimmune disease in which the body’s immune system attacks myelin, the protective covering that surrounds nerve fibers in the brain and spinal cord. Think of myelin like insulation around an electrical wire. When it is damaged, nerve signals slow down or are blocked entirely, leading to a wide range of physical, cognitive, and emotional symptoms (Hittle et al., 2023).

MS is the most common progressive neurological condition causing disability in young and middle-aged adults. More than 1 million Americans are living with MS, and the condition is nearly three times more common in women than men. It is typically diagnosed between the ages of 20 and 50, though it can occur at any age (Hittle et al., 2023).

The cause of MS is not fully understood, but researchers believe it involves a combination of genetic susceptibility and environmental triggers such as Epstein-Barr virus exposure, low vitamin D levels, and smoking. There is currently no cure for MS, but disease-modifying therapies and rehabilitation can dramatically slow progression and improve daily function. Research consistently shows that comprehensive rehabilitation, including occupational therapy (OT), physical therapy (PT), and speech-language pathology (SLP), produces significantly better outcomes than medication alone (Marcu et al., 2023).

2. Types of MS

MS is not a single condition. It presents in distinct clinical patterns, each with different implications for rehabilitation planning:

• Relapsing-Remitting MS (RRMS) is the most common form, affecting about 85% of people at diagnosis. It is characterized by periods of new or worsening symptoms (relapses) followed by periods of partial or full recovery (remissions). Rehabilitation is particularly valuable during remission to maximize function.
• Secondary Progressive MS (SPMS) is a stage that many people with RRMS eventually transition to, where disability worsens more steadily over time, with or without relapses.
• Primary Progressive MS (PPMS) is characterized by steady worsening from the onset, without distinct relapses. Rehabilitation focuses on maintaining function and slowing decline.
• Clinically Isolated Syndrome (CIS) is a first episode of neurological symptoms consistent with MS. It is not yet a formal MS diagnosis, but rehabilitation may still be warranted.

Understanding which type of MS a person has helps therapists set appropriate goals and pace interventions. For progressive forms, the goal shifts from recovery to preservation of function and quality of life (Kos et al., 2026).

3. Common Symptoms

MS affects the brain and spinal cord, which control virtually every body function, meaning symptoms vary enormously from person to person. The most common symptoms that affect daily life and function include:

• Fatigue is the most prevalent and disabling symptom, reported by up to 80% of people with MS. Unlike typical tiredness, MS fatigue can be overwhelming and unpredictable, often worsening with heat in a phenomenon known as Uhthoff’s phenomenon.
• Walking and balance difficulties affect approximately half of people with MS within five years of diagnosis (Plummer et al., 2023).
• Muscle weakness and spasticity refer to stiffness or involuntary muscle tightening, particularly in the legs.
• Numbness and tingling can affect the face, arms, legs, or trunk.
• Vision problems include blurred vision, double vision, or optic neuritis, which is inflammation of the optic nerve.
• Cognitive changes affect attention, processing speed, memory, and executive function in 40 to 65% of people with MS (Tacchino et al., 2023).
• Bladder and bowel dysfunction are among the most common and impactful symptoms affecting quality of life.
• Pain includes neuropathic pain, trigeminal neuralgia, and musculoskeletal pain from altered movement patterns.
• Speech and swallowing difficulties: dysarthria (slurred speech) occurs in approximately 40% of people with MS (Plotas et al., 2023).
• Depression and anxiety are more common in MS than in any other chronic neurological condition.

No two people with MS experience exactly the same combination of symptoms. Rehabilitation is most effective when it is individually tailored to each person’s specific presentation and goals (Kos et al., 2026).

4. Occupational Therapy for MS

Occupational therapists (OTs) are central members of the MS rehabilitation team. OT addresses the physical, cognitive, and environmental factors that affect a person’s ability to engage in the daily activities that matter most to them, from dressing and cooking to working and driving. A 2026 Cochrane systematic review confirmed that OT is a valuable component of MS care and improves daily functioning, participation, and quality of life (Kos et al., 2026).

Fatigue Management

Energy conservation (planning activities to avoid exhaustion), work simplification, and cognitive-behavioral approaches to fatigue are among the most evidence-supported OT interventions for MS. OTs help people establish sustainable daily routines that balance activity and rest (Yu et al., 2025).

Activities of Daily Living (ADL)

OTs address dressing, bathing, grooming, meal preparation, and household management, adapting tasks, tools, and environments to match the person’s current level of function. Strong evidence supports targeted exercise and dexterity training programs for improving ADL performance in MS (Yu et al., 2025).

Fall Prevention and Functional Mobility

Falls are a significant safety concern for people with MS. OT provides falls education, targeted exercise programs, and home hazard modification. Strong evidence supports the combination of tailored exercise and education to reduce falls in ambulatory adults with MS (Yu et al., 2025).

Home and Environment Modification

OTs recommend and arrange adaptive equipment such as grab bars, shower chairs, raised toilet seats, reachers, weighted utensils, and smart home technologies to maintain independence as function changes over time.

Cognitive Strategy Training

For people experiencing cognitive changes, OTs provide compensatory strategy training using calendars, reminders, checklists, and structured routines to support memory, attention, and executive function in daily life (Tacchino et al., 2023).

Sleep and Sexual Activity

OTs address sleep disturbances through cognitive-behavioral therapy (CBT) and mindfulness approaches. They also provide counseling around sexual function. Strong evidence supports the use of the PLISSIT (Permission, Limited Information, Specific Suggestions, Intensive Therapy) counseling model for addressing sexual dysfunction in women with MS (Yu et al., 2025).

5. Physical Therapy for MS

Physical therapists (PTs) play a critical role in maintaining and improving mobility, strength, balance, and endurance in people with MS. Exercise is one of the best-supported rehabilitation interventions across all MS types and disability levels (Du et al., 2024).

A comprehensive 2024 meta-analysis of 84 studies found that exercise significantly improved balance, walking ability, walking endurance, fatigue, and quality of life in people with MS. Mind-body exercise and resistance training produced the largest reductions in fatigue, while aerobic and combined exercise programs improved walking endurance most effectively (Zhang et al., 2024).

PT for MS commonly addresses:

• Gait training improves walking safety, speed, and endurance through treadmill training, overground gait exercises, and assistive device training.
• Balance and fall prevention include static and dynamic balance exercises, vestibular rehabilitation, and virtual reality-based training programs.
• Strength and flexibility address progressive resistance training for lower and upper extremities, core stabilization, and stretching programs for spasticity management.
• Aerobic conditioning uses low-to-moderate intensity aerobic exercise to combat fatigue and improve cardiovascular fitness.
• Spasticity management includes positioning, stretching, and movement strategies to reduce muscle stiffness.
• Assistive technology and orthotics involve recommending and training in the use of ankle-foot orthoses (AFOs), canes, walkers, and wheelchairs as needed.

Research with people living with MS shows that patients and clinicians prioritize safety and functional independence over gait speed alone. Physical therapists are most effective when they focus on outcomes meaningful to the individual, such as fall reduction and ability to get out into the community (Plummer et al., 2023).

6. Speech-Language Pathology for MS

Speech-language pathologists (SLPs) address communication and swallowing challenges that are common but often underrecognized in MS. Up to 40% of people with MS develop dysarthria (slurred or unclear speech), and swallowing difficulties, known as dysphagia, affect a significant proportion as the disease progresses (Plotas et al., 2023; Restivo et al., 2024).

Speech and Voice

MS-related speech changes most commonly include reduced speech volume, slower rate, imprecise articulation, and monotone or scanning speech, a distinctive pattern where equal stress is placed on each syllable. Dysarthria in MS typically has both spastic and ataxic components due to damage in the corticospinal and cerebellar pathways. SLP interventions include breath support training, Lee Silverman Voice Treatment (LSVT LOUD), pacing strategies, and augmentative and alternative communication (AAC) for those with more severe involvement (Plotas et al., 2023).

Swallowing

Dysphagia in MS can affect any phase of swallowing, including oral preparation, oral transport, pharyngeal, and esophageal phases, and carries risks of aspiration (food or liquid entering the airway), aspiration pneumonia, malnutrition, and dehydration. Assessment may include a clinical swallowing evaluation and instrumental studies such as a videofluoroscopic swallowing study (VFSS) or fiberoptic endoscopic evaluation of swallowing (FEES). Interventions include dietary texture modification, compensatory swallowing strategies, and swallowing exercises (Restivo et al., 2024).

Cognitive-Communication

When cognitive impairment affects communication, such as word-finding difficulties, reduced verbal memory, or trouble organizing complex thoughts, SLPs provide cognitive-communication therapy alongside OT cognitive strategy training. SLPs also use MS-specific cognitive tools such as the Symbol Digit Modalities Test (SDMT), which is highly sensitive to the processing speed deficits that characterize MS-related cognitive impairment (Tacchino et al., 2023).

7. Managing MS Fatigue

Fatigue is the most prevalent and often the most disabling symptom of MS. Unlike typical tiredness, MS fatigue, sometimes called lassitude, is not relieved by rest alone, can occur without physical exertion, and often worsens in heat. It significantly limits work, social participation, and the ability to perform everyday activities (Zhang et al., 2024).

Effective fatigue management in MS is interdisciplinary and may include:

• Energy conservation training (OT) uses activity pacing, work simplification, priority-setting, and planning the most demanding tasks for peak energy times.
• Exercise prescription (PT) is important because regular structured exercise reduces MS fatigue over time. Resistance training and mind-body exercise show the strongest effects (Zhang et al., 2024).
• Cognitive-behavioral therapy (CBT) has strong evidence supporting its use for reducing fatigue’s impact on daily life, sleep, and mood (Yu et al., 2025).
• Sleep hygiene and treatment (OT/SLP) reduce daytime fatigue by treating underlying sleep disorders.
• Cooling strategies such as cooling vests, cool showers, and air conditioning reduce heat-related fatigue associated with Uhthoff’s phenomenon.
• Medication management is prescribed by the neurologist. Rehabilitation works best when fatigue management strategies complement any pharmacological treatment.

8. Cognitive Changes in MS

Cognitive impairment is present in 40 to 65% of people with MS and can occur at any stage, including early in the disease course, even before significant physical disability appears. The most commonly affected domains are information processing speed, verbal and visual memory, attention, and executive function, which refers to higher-level planning and problem-solving (Tacchino et al., 2023).

Cognitive rehabilitation is an evidence-based intervention that aims to reduce the functional impact of cognitive impairment through two main strategies: restorative approaches, which are exercises designed to improve the impaired function itself, and compensatory approaches, which teach strategies to work around the impairment in daily life. Digital tools, smartphone apps, and computer-based training programs are increasingly being used to deliver cognitive rehabilitation in accessible, home-based formats (Tacchino et al., 2023).

OTs, SLPs, and neuropsychologists all contribute to cognitive rehabilitation in MS. OTs focus on applying cognitive strategies to specific daily occupations such as meal planning, medication management, and work tasks. SLPs address the communication aspects of cognitive impairment. Neuropsychologists provide formal assessment and rehabilitation programs. A coordinated approach across disciplines produces the best outcomes for people with MS-related cognitive changes.

9. Living Well with MS

MS is a lifelong condition, and living well with it requires ongoing self-management, strong professional support, and a proactive approach to maintaining function. Research comparing rehabilitation to drug therapy alone found that people who engaged in regular PT and OT showed significantly better mobility, dexterity, and ADL performance than those receiving medication only, underscoring that rehabilitation is not optional but essential (Marcu et al., 2023).

Key principles for living well with MS include maintaining regular physical activity, engaging with an interdisciplinary rehabilitation team at key transition points such as diagnosis, relapse, and functional decline, addressing mental health proactively (depression is both more common and more underdiagnosed in MS than in most other neurological conditions), and connecting with peer support and MS-specific organizations such as the National Multiple Sclerosis Society at nationalmssociety.org.

Regular re-evaluation, rather than a single episode of care, is the recommended model for MS rehabilitation. Because MS is progressive, therapy goals and strategies need to evolve as the person’s needs change. Telehealth and home-based therapy programs are increasingly supported by evidence as effective alternatives for people with limited mobility or access to in-person services (Plummer et al., 2023).

10. What Families Can Do

Family members play an indispensable role in the lives of people living with MS, particularly as the disease progresses. Informed, engaged family support makes a measurable difference in how well a person maintains function, manages symptoms, and navigates the healthcare system.

• Learn about MS. Understanding the disease, its variability, and what symptoms mean helps families provide effective support and advocate for appropriate care. The National Multiple Sclerosis Society (nationalmssociety.org) provides free, reliable resources for families.
• Encourage activity without enabling dependence. Allow the person with MS to attempt tasks independently before offering assistance. Doing tasks for someone too readily can reduce their motivation, slow their rehabilitation progress, and undermine their sense of competence. Support participation, not passivity.
• Help manage fatigue. Assist with scheduling the most demanding tasks for the times of day when energy is highest. Help reduce unnecessary exertion, noise, heat, and stress in the home environment.
• Attend therapy sessions when possible. Observing therapy gives families insight into what the therapist is working on, how to reinforce strategies at home, and how to safely assist with exercises and daily tasks.
• Watch for signs of depression. Depression is significantly more common in MS than in the general population and is frequently underidentified. Persistent low mood, withdrawal from activities and social interaction, loss of motivation, and changes in sleep and appetite should be reported to the medical team promptly.
• Support cognitive changes with structure. People with MS-related cognitive impairment benefit from predictable routines, reduced cognitive load, written reminders, and a calm, organized environment. These are strategies the OT can help design specifically for your home.
• Plan ahead for changing needs. MS is progressive for many people. Discussing future care preferences, home modification needs, and driving safety before a crisis makes transitions easier for everyone.
• Prioritize your own wellbeing. Caregiver fatigue and burnout are common among people supporting a loved one with MS. Your health, emotional wellbeing, and social connections matter. Seek caregiver support programs, counseling, or respite services as needed.
• Know when to seek emergency care. A sudden worsening of MS symptoms, a new neurological symptom, or a fall with injury should be evaluated medically. Do not assume all worsening symptoms are simply MS progression without checking with the neurologist.

References

1. Du, L., Xi, H., Zhang, S., Zhou, Y., Tao, X., Lv, Y., Hou, X., & Yu, L. (2024). Effects of exercise in people with multiple sclerosis: a systematic review and meta-analysis. Frontiers in Public Health, 12, 1387658. https://doi.org/10.3389/fpubh.2024.1387658
2. Hittle, M., Culpepper, W. J., Langer-Gould, A., Marrie, R. A., Cutter, G. R., Kaye, W. E., Wagner, L., Topol, B., LaRocca, N. G., Nelson, L. M., & Wallin, M. T. (2023). Population-based estimates for the prevalence of multiple sclerosis in the United States by race, ethnicity, age, sex, and geographic region. JAMA Neurology, 80(7), 693–701. https://doi.org/10.1001/jamaneurol.2023.1135
3. Kos, D., Boers, A., O’Meara, C., Bekkering, G. E., De Coninck, L., Koen, M., Freeman, J., Hynes, S. M., & Eijssen, I. C. J. M. (2026). Occupational therapy for multiple sclerosis. Cochrane Database of Systematic Reviews, 2026(1), CD015371. https://doi.org/10.1002/14651858.CD015371.pub2
4. Marcu, F. M., Ciobanu, D., Boca, I. C., Sirbu, E., Deme, P. A., Hreniuc, N. C., & Ianc, D. (2023). Rehabilitation therapy versus drug-only therapy in patients with multiple sclerosis. Turkish Journal of Medical Sciences, 54(1), 157–164. https://doi.org/10.55730/1300-0144.5776
5. Plummer, P., Stewart, A., & Anderson, J. N. (2023). Patient and clinician perspectives of physical therapy for walking difficulties in multiple sclerosis. Multiple Sclerosis International, 2023, 1121051. https://doi.org/10.1155/2023/1121051
6. Plotas, P., Nanousi, V., Kantanis, A., Tsiamaki, E., Papadopoulos, A., Tsapara, A., Glyka, A., Mani, E., Roumelioti, F., Strataki, G., Fragkou, G., Mavreli, K., Ziouli, N., & Trimmis, N. (2023). Speech deficits in multiple sclerosis: a narrative review of the existing literature. European Journal of Medical Research, 28(1), 252. https://doi.org/10.1186/s40001-023-01230-3
7. Restivo, D. A., Quartarone, A., Bruschetta, A., Alito, A., Milardi, D., Marchese-Ragona, R., Iezzi, E., Peter, S., Centonze, D., & Stampanoni Bassi, M. (2024). Dysphagia in multiple sclerosis: pathophysiology, assessment, and management, an overview. Frontiers in Neurology, 15, 1514644. https://doi.org/10.3389/fneur.2024.1514644
8. Tacchino, A., Podda, J., Bergamaschi, V., Pedullà, L., & Brichetto, G. (2023). Cognitive rehabilitation in multiple sclerosis: Three digital ingredients to address current and future priorities. Frontiers in Human Neuroscience, 17, 1130231. https://doi.org/10.3389/fnhum.2023.1130231
9. Yu, C.-H., Foidel, S., & Toth-Cohen, S. (2025). Occupational therapy interventions addressing activities of daily living and sleep for people with multiple sclerosis: A systematic review. International Journal of MS Care, 27(Q4). https://doi.org/10.7224/1537-2073.2025-013
10. Zhang, X.-N., Liang, Z.-D., & Li, M.-D. (2024). Comparison of different exercise modalities on fatigue and muscular fitness in patients with multiple sclerosis: a systematic review with network, and dose-response meta-analyses. Frontiers in Neurology, 15, 1494368. https://doi.org/10.3389/fneur.2024.1494368

Also See

• Stroke Recovery — Rehabilitation approaches for motor, cognitive, and ADL deficits following stroke
• Parkinson’s Disease — Managing motor symptoms, gait, speech, and independence in Parkinson’s through multidisciplinary therapy
• Traumatic Brain Injury (TBI) — Cognitive, behavioral, and functional rehabilitation following TBI
• Dementia & Alzheimer’s Disease — Memory, cognition, ADL support, and caregiver training across all stages
• Fall Prevention — Balance assessment, home hazard reduction, and evidence-based exercise programs
• Adaptive Driving — Vehicle modifications, adaptive equipment, and driver rehabilitation for people with disabilities

© TherapyTopics.com — All information is for educational purposes only and does not constitute medical or therapeutic advice. Consult a licensed therapist or physician for evaluation and treatment.

© TherapyTopics.com — All information is for educational purposes only and does not constitute medical or therapeutic advice. Consult a licensed therapist or physician for evaluation and treatment.