Highlights
- •Many beneficial rehabilitation therapies exist for patients with multiple sclerosis.
- •Patient-centred plans that include goal setting are crucial aspects of therapy.
- •Exercise therapy offers physical, cognitive and psychological benefits for patients.
- •Both in- and out-patient settings can provide patient condition-dependant benefits.
- •Measurable improvements should be seen in impairment, activity and participation.
Abstract
Multiple sclerosis (MS) is a chronic, debilitating disease characterised by demyelination
of the nerves of the central nervous system that results in patients progressively
losing the ability to perform daily tasks. As there is no cure for this disease, rehabilitation
therapy is an important aspect of care; assisting patients to regain or retain function
and improve their physical, mental and social wellbeing. At present there is no current
consistent model of care for MS, likely due to the variable symptom presentation.
Various forms of rehabilitation therapy are available, and these include physical
rehabilitation methods, such as balance and gait therapy, speech and respiration rehabilitation,
and occupational therapy. Contrary to previous understanding, exercise-based therapies
have shown various benefits for patients with MS, and in addition to improving MS-related
physical symptoms, have been shown to reduce the risk of developing cardiovascular
disease and can improve cognitive function. Cognition rehabilitation therapy specifically
focuses on behavioural tasks and is divided into two main forms: compensatory rehabilitation,
which offers cognitive functioning benefits, and restorative rehabilitation, which
offers memory benefits. Excitation therapies include cranial stimulation and other
stimulation rehabilitation methods such as focal muscle vibration therapy and these
non-invasive techniques may improve patient's physical ability. Additionally, more
novel rehabilitation methods include robot-assisted gait therapy and telerehabilitation,
both of which are expected to play progressively more prominent roles in the future
of rehabilitation therapy. The structure of the care team has been found to impact
patient outcomes, and both in- and out-patient care settings have been found to be
beneficial, dependant on the patient's circumstances, with certain patients better
suited to a particular setting. While a single point of care is recommended for patients,
a multidisciplinary care team and regular reassessment is recommended to manage changing
symptoms and ensure continuity of care. The importance of the critical components
of rehabilitation have been identified, and these are of vital importance in achieving
beneficial outcomes. These components include the patients’ participation in the treatment,
goal setting with a multidisciplinary care team, a guiding-light purpose for the patient,
which focusses on recognizing their personal potential and obtaining improvements
through a tailored plan. The final critical component of rehabilitation is the results
measurement, which highlights the need for a quantifiable reduction in impairment
and improvement in activity and participation. Overall, a lack of standardisation
in outcome measurements makes comparison challenging. This is particularly important
when comparing standard methods of care with more novel rehabilitation techniques.
However, within the broad area of rehabilitation therapies, it is clear that patients
with MS can benefit from rehabilitation practices; physically, mentally and socially.
Keywords
Abbreviations:
6MWT (6-minute walk test), AFO (ankle foot orthoses), CI (confidence interval), EDSS (expanded disability status scale), FES (functional electrical stimulation), FMV (focal muscle vibration), IL (interleukin), MS (multiple sclerosis), NIBS (non-invasive brain stimulation), NICE (National Institute of Health and Care Excellence), PAS (penetration and aspiration scale), RAGT (robot-assisted gait training), SWAL QOL (swallow-related quality-of-life assessment), QoL (Quality of Life), TENS (transcutaneous electrical nerve stimulation)To read this article in full you will need to make a payment
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References
- Focal muscle vibration: evaluation of physical properties and his applications.Senses. Sci. 2014; 1: 24-29https://doi.org/10.14616/sands-2014-1-2429
- Assessing effectiveness and costs in robot-mediated lower limbs rehabilitation: a meta-analysis and state of the art.J. Healthc. Eng. 2018; (2018)7492024https://doi.org/10.1155/2018/7492024
- Focal muscle vibration, an effective rehabilitative approach in severe gait impairment due to multiple sclerosis.J. Neurolog. Sci. 2017; 372: 33-39https://doi.org/10.1016/j.jns.2016.11.025
- Reflex locomotion therapy for balance, gait, and fatigue rehabilitation in subjects with multiple sclerosis.J. Clin. Med. 2022; 11: 567https://doi.org/10.3390/jcm11030567
- Effectiveness of virtual reality training for balance and gait rehabilitation in people with multiple sclerosis: a systematic review and meta-analysis.Clin. Rehabil. 2018; 32: 1220-1234https://doi.org/10.1177/0269215518768084
- Factors influencing balance improvement in multiple sclerosis rehabilitation: a pragmatic multicentric trial.Ann. Phys. Rehabil. Med. 2020; 63: 93-98https://doi.org/10.1016/j.rehab.2019.05.007
- Computer-assisted cognitive rehabilitation of attention deficits for multiple sclerosis: a randomized trial with fMRI correlates.Neurorehabil. Neural. Repair. 2013; 27: 284-295https://doi.org/10.1177/1545968312465194
- Neurological update: cognitive rehabilitation in multiple sclerosis.J. Neurol. 2021; 268: 4908-4914https://doi.org/10.1007/s00415-021-10618-2
- Effects of repetitive transcranial magnetic stimulation in multiple sclerosis: a systematic review and meta-analysis.Mult. Scler. Relat. Disord. 2022; 59103564https://doi.org/10.1016/j.msard.2022.103564
- Expiratory muscle strength training: speech production outcomes in patients with multiple sclerosis.Neurorehabil. Neural. Repair. 2007; 21: 239-249https://doi.org/10.1177/1545968306294737
- An RCT to treat learning impairment in multiple sclerosis: the MEMREHAB trial.NeurologyNeurology. 2013; 81: 2066-2072https://doi.org/10.1212/01.wnl.0000437295.97946.a8
- Impact of COVID-19 pandemic on frequency of clinical visits, performance of MRI studies, and therapeutic choices in a multiple sclerosis referral centre.J. Neurol. 2022; 269: 1764-1772https://doi.org/10.1007/s00415-021-10958-z
- Interventions for instrumental activities of daily living among adults with multiple sclerosis: a systematic review.Am. J. Occup. Ther. 2022; 767602205130https://doi.org/10.5014/ajot.2022.049092
- Exercise therapy in multiple sclerosis and its effects on function and the brain.Neurodegener. Dis. Manag. 2017; 7: 35-40https://doi.org/10.2217/nmt-2017-0040
- Moving exercise research in multiple sclerosis forward (the MoXFo initiative): developing consensus statements for research.Mult. Scler. J. 2020; 26: 1303-1308https://doi.org/10.1177/1352458520910360
- Clinical assessment of orofacial manifestations in 500 patients with multiple sclerosis.J. Oral. Maxillofac. Surg. 2013; 71: 290-294https://doi.org/10.1016/j.joms.2012.05.008
- Occupational therapy interventions in adults with multiple sclerosis or amyotrophic lateral sclerosis: a scoping review.Int. J. Environ. Res. Public. Health. 2021; 18: 1432https://doi.org/10.3390/ijerph18041432
- The effect of wheelchair use on the quality of life of persons with multiple sclerosis.Occup. Ther. Health. Care. 2004; 17: 63-79https://doi.org/10.1080/J003v17n03_05
- Effectiveness of physiotherapy interventions on spasticity in people with multiple sclerosis: a systematic review and meta-analysis.Am. J. Phys. Med. Rehabil. 2018; 97: 793-807https://doi.org/10.1097/PHM.0000000000000970
- Using telerehabilitation to support people with multiple sclerosis: a qualitative analysis of interactions, processes, and issues across three interventions.Br. J. Occup. Ther. 2017; 80: 259-268https://doi.org/10.1177/0308022617690405
- Applications of transcranial direct current stimulation for understanding brain function.Trends. Neurosci. 2014; 37: 742-753https://doi.org/10.1016/j.tins.2014.08.003
- Telemedicine in rehabilitation.Phys. Med. Rehabil. Clin. North. Am. 2019; 30: 473-483https://doi.org/10.1016/j.pmr.2018.12.002
- Speed-and cane-related alterations in gait parameters in individuals with multiple sclerosis.Gait. Posture. 2011; 33: 140-142https://doi.org/10.1016/j.gaitpost.2010.09.016
- Combined exercise training reduces IFN-γ and IL-17 levels in the plasma and the supernatant of peripheral blood mononuclear cells in women with multiple sclerosis.Int. Immunopharmacol. 2010; 10: 1415-1419https://doi.org/10.1016/j.intimp.2010.08.008
- Clinical management of metabolic syndrome: report of the American Heart Association/National Heart, Lung, and Blood Institute/American Diabetes Association conference on scientific issues related to management.CirculationCirculation. 2004; 109: 551-556https://doi.org/10.1161/01.CIR.0000112379.88385.67
- Comprehensive Nursing Care in Multiple Sclerosis.Demos Medical Publishing, New York, New York2002 (2nd ed.)
- American Academy of Neurology Telehealth Position Statement.NeurologyNeurology. 2021; 97: 334-339https://doi.org/10.1212/WNL.0000000000012185
Heine, M., van de Port, I., Rietberg, M.B., et al., 2015. Exercise therapy for fatigue in multiple sclerosis. Cochrane. Database. Syst. Rev. (9), CD009956. https://doi.org/10.1002/14651858.CD009956.pub2.
- Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls?.Age. Ageing. 2006; 35 (ii7-ii11)https://doi.org/10.1093/ageing/afl077
- Effects of transcranial direct current stimulation on cognition, mood, pain, and fatigue in multiple sclerosis: a systematic review and meta-analysis.Front. Neurol. 2021; 12626113https://doi.org/10.3389/fneur.2021.626113
- Mobility difficulties are not only a problem of old age.J. Gen. Intern. Med. 2001; 16: 235-243https://doi.org/10.1046/j.1525-1497.2001.016004235.x
- An integrative cognitive rehabilitation using neurologic music therapy in multiple sclerosis: a pilot study.Medicine. (Baltimore). 2020; 99 (e18866-e18866)https://doi.org/10.1097/MD.0000000000018866
- Anodal transcranial direct current stimulation of motor cortex does not ameliorate spasticity in multiple sclerosis.Restor. Neurol. Neurosci. 2015; 33: 487-492https://doi.org/10.3233/RNN-150495
- The therapeutic use of non-invasive brain stimulation in multiple sclerosis–a review.Restor. Neurol. Neurosci. 2017; 35: 497-509https://doi.org/10.3233/RNN-170735
- Transcutaneous electrical nerve stimulation.Cont. Educ. Anaesthes. Crit. Care. Pain. 2009; 9: 130-135https://doi.org/10.1093/bjaceaccp/mkp021
- Muscle strength and power in persons with multiple sclerosis–a systematic review and meta-analysis.J. Neurolog. Sci. 2017; 376: 225-241https://doi.org/10.1016/j.jns.2017.03.022
- The relationship between specific cognitive domains, fear of falling, and falls in people with multiple sclerosis.Biomed. Res. Int. 2014; (2014)281760https://doi.org/10.1155/2014/281760
- Gait and cognitive impairments in multiple sclerosis: the specific contribution of falls and fear of falling.J. Neural. Transm. 2017; 124: 1407-1416https://doi.org/10.1007/s00702-017-1765-0
- A personalized, intense physical rehabilitation program improves walking in people with multiple sclerosis presenting with different levels of disability: a retrospective cohort.BMC. Neurol. 2015; 15: 21https://doi.org/10.1186/s12883-015-0281-9
- Effects of non-invasive brain stimulation in multiple sclerosis: systematic review and meta-analysis.Ther. Adv. Chronic. Dis. 2022; 13 (20406223211069198)https://doi.org/10.1177/20406223211069198
- Understanding and treating balance impairment in multiple sclerosis.JCOM. 2014; 21: 419-432
- Symptomatic therapy and neurorehabilitation in multiple sclerosis.Lancet. Neurol. 2005; 4: 643-652https://doi.org/10.1016/S1474-4422(05)70193-9
- Multidisciplinary rehabilitation for adults with multiple sclerosis.Cochrane. Database. Syst. Rev. 2007; (CD006036)https://doi.org/10.1002/14651858.CD006036.pub2
- Can resistance training impact MRI outcomes in relapsing-remitting multiple sclerosis?.Mult. Scler. J. 2018; 24: 1356-1365https://doi.org/10.1177/1352458517722645
- Neuromuscular adaptations to long-term progressive resistance training translates to improved functional capacity for people with multiple sclerosis and is maintained at follow-up.Mult. Scler. J. 2015; 21: 599-611https://doi.org/10.1177/1352458514549402
- Effectiveness of cognitive rehabilitation for people with multiple sclerosis: a meta-synthesis of patient perspectives.Neuropsychol. Rehabil. 2019; 29: 491-512https://doi.org/10.1080/09602011.2017.1309323
- Respiratory rehabilitation in multiple sclerosis: a narrative review of rehabilitation techniques.Ann. Phys. Rehabil. Med. 2018; 61: 38-45https://doi.org/10.1016/j.rehab.2017.06.002
- Physical activity and multiple sclerosis: a meta-analysis.Mult. Scler. 2005; 11: 459-463https://doi.org/10.1191/1352458505ms1188oa
- Multiple Sclerosis in adults: Management.Clinical guideline: multiple sclerosis in adults: management, 2014 (CG186) (Accessed 7 April 2022)
National Institute for Health and Care Excellence, 2016. Multiple Sclerosis Quality Standard [QS108]. www.nice.org.uk/guidance/qs108. (Accessed 7 April 2022).
- Balance exercise program reduced falls in people with multiple sclerosis: a single-group, pretest-posttest trial.Arch. Phys. Med. Rehabil. 2014; 95: 2428-2434https://doi.org/10.1016/j.apmr.2014.06.016
- What speech can tell us: a systematic review of dysarthria characteristics in multiple sclerosis.Autoimmun. Rev. 2018; 17: 1202-1209https://doi.org/10.1016/j.autrev.2018.06.010
- Physical functioning in multiple sclerosis: a population-based study in central Finland.J. Rehabil. Med. 2006; 38: 339-345https://doi.org/10.1080/16501970600731537
- Effects of expiratory muscle strength training on maximal respiratory pressure and swallow-related quality of life in individuals with multiple sclerosis.Mult. Scler. J. Exp. Transl. Clin. 2017; 32055217317710829https://doi.org/10.1177/2055217317710829
- Multidisciplinary data infrastructures in multiple sclerosis: why they are needed and can be done!.Mult. Scler. J. 2019; 25: 500-509https://doi.org/10.1177/1352458518807076
- The safety of exercise training in multiple sclerosis: a systematic review.J. Neurolog. Sci. 2014; 343: 3-7https://doi.org/10.1016/j.jns.2014.05.016
- Cognitive impairment in different MS subtypes and clinically isolated syndromes.J. Neurolog. Sci. 2008; 267: 100-106https://doi.org/10.1016/j.jns.2007.10.002
- The ability of clinical balance measures to identify falls risk in multiple sclerosis: a systematic review and meta-analysis.Clin. Rehabil. 2018; 32: 571-582https://doi.org/10.1177/0269215517748714
- Achieving patient engagement in multiple sclerosis: a perspective from the multiple sclerosis in the 21st Century Steering Group.Mult. Scler. Relat. Disord. 2015; 4: 202-218https://doi.org/10.1016/j.msard.2015.02.005
- Age and disability drive cognitive impairment in multiple sclerosis across disease subtypes.Mult. Scler. J. 2017; 23: 1258-1267https://doi.org/10.1177/1352458516674367
- Effect of combination exercise therapy on walking distance, postural balance, fatigue and quality of life in multiple sclerosis patients: a clinical trial study.Iran. Red. Crescent. Med. J. 2014; 16 (e17173-e17173)https://doi.org/10.5812/ircmj.17173
- Systematic review of efficacy of TENS for management of central pain in people with multiple sclerosis.Mult. Scler. Relat. Disord. 2015; 4: 219-227https://doi.org/10.1016/j.msard.2015.03.006
- Psychiatric and physical comorbidities and pain in patients with multiple sclerosis.J. Pain. Res. 2018; 11: 325-334https://doi.org/10.2147/JPR.S146717
- Effects of different focus of attention rehabilitative training on gait performance in multiple sclerosis patients.J. Bodyw. Mov. Ther. 2013; 17: 28-34https://doi.org/10.1016/j.jbmt.2012.04.005
- Telerehabilitation benefits patients with multiple sclerosis in an urban setting.J. Telemed. Telecare. 2021; 27: 39-45https://doi.org/10.1177/1357633×19861830
- Exercise-induced increase in blood-based brain-derived neurotrophic factor (BDNF) in people with multiple sclerosis: a systematic review and meta-analysis of exercise intervention trials.PLoS. ONE. 2022; 17 (e0264557)https://doi.org/10.1371/journal.pone.0264557
- Symptom change with exercise is a temporary phenomenon for people with multiple sclerosis.Arch. Phys. Med. Rehabil. 2006; 87: 723-727https://doi.org/10.1016/j.apmr.2006.01.015
- Dual task training in persons with multiple sclerosis: a feasability randomized controlled trial.Clin. Rehabil. 2017; 31: 1322-1331https://doi.org/10.1177/0269215517698028
- The effects of mechanical focal vibration on walking impairment in multiple sclerosis patients: a randomized, double-blinded vs placebo study.Restor. Neurol. Neurosci. 2016; 34: 869-876https://doi.org/10.3233/RNN-160665
- The effect of traditional dysphagia therapy on the swallowing function in patients with multiple sclerosis: a pilot double-blinded randomized controlled trial.J. Bodyw. Mov. Ther. 2019; 23: 171-176https://doi.org/10.1016/j.jbmt.2018.01.016
Taylor, L.A., Mhizha-Murira, J.R., Smith, L., et al., 2021. Memory rehabilitation for people with multiple sclerosis. Cochrane. Database. Syst. Rev. (10), CD008754. https://doi.org/10.1002/14651858.CD008754.pub4.
- Dysphagia and nutritional status in multiple sclerosis.J. Neurol. 1999; 246: 677-682https://doi.org/10.1007/s004150050431
Thompson, A.J., 2001. Symptomatic management and rehabilitation in multiple sclerosis. J. Neurol. Neurosurg. Psychiatry. Res 71 (suppl 2), ii22-ii27. https://doi.org/10.1136/jnnp.71.suppl_2.ii22.
- Telerehabilitation solution conceptual paper for community-based exercise rehabilitation of patients discharged after critical illness.Int. J. Telerehabil. 2016; 8: 61-70https://doi.org/10.5195/ijt.2016.6205
- Telephone counseling and home telehealth monitoring to improve medication adherence: results of a pilot trial among individuals with multiple sclerosis.Rehabil. Psychol. 2014; 59: 136-146https://doi.org/10.1037/a0036322
- Treadmill training for individuals with multiple sclerosis: a pilot randomised trial.J. Neurol. Neurosurg. Psychiatry. Res. 2006; 77: 531-533https://doi.org/10.1136/jnnp.2005.064410
- Risk and safety of repetitive transcranial magnetic stimulation: report and suggested guidelines from the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation, June 5–7, 1996.Electroencephalography. Clinic. Neurophys./Evoked. Potentials. Section. 1998; 108: 1-16https://doi.org/10.1016/s0168-5597(97)00096-8
- Risk factors related to cardiovascular diseases and the metabolic syndrome in multiple sclerosis–a systematic review.Mult. Scler. J. 2013; 19: 1556-1564https://doi.org/10.1177/1352458513504252
- Exercise and multiple sclerosis.Sports. Med. 2004; 34: 1077-1100https://doi.org/10.2165/00007256-200434150-00005
- Do patients with multiple sclerosis derive more benefit from robot-assisted gait training compared with conventional walking therapy on motor function? A meta-analysis.Front. Neurol. 2017; 8: 260https://doi.org/10.3389/fneur.2017.00260
- Systematic review of occupational therapy–related interventions for people with multiple sclerosis: part 1. Activity and participation.Am. J. Occup. Ther. 2014; 68: 27-32https://doi.org/10.5014/ajot.2014.008672
- Systematic review of occupational therapy–related interventions for people with multiple sclerosis: part 2. Impairment.Am. J. Occup. Ther. 2014; 68: 33-38https://doi.org/10.5014/ajot.2014.008680
- Computer-assisted rehabilitation of attention in patients with multiple sclerosis: results of a randomized, double-blind trial.Mult. Scler. J. 2014; 20: 91-98https://doi.org/10.1177/1352458513501571
- Cognitive impairment in early stages of multiple sclerosis.Neurolog. Sci. 2010; 31: 211-214https://doi.org/10.1007/s10072-010-0376-4
- The effect of aquatic physical therapy on patients with multiple sclerosis: a systematic review and meta-analysis.Mult. Scler. Relat. Disord. 2020; 41102022https://doi.org/10.1016/j.msard.2020.102022
- Occupational therapy practice framework: domain and process – fourth edition.Am. J. Occup. Ther. 2020; 74 (Suppl 2): 1-87https://doi.org/10.5014/ajot.2020.74S2001
- Goals set after completing a teleconference-delivered program for managing multiple sclerosis fatigue.Am. J. Occup. Ther. 2015; 69: 1-8https://doi.org/10.5014/ajot.2015.015370
- Integrated cognitive and neuromotor rehabilitation in multiple sclerosis: a pragmatic study.Front. Behav. Neurosci. 2018; 12: 196https://doi.org/10.3389/fnbeh.2018.00196
- What is the impact of robotic rehabilitation on balance and gait outcomes in people with multiple sclerosis? A systematic review of randomized control trials.Eur. J. Phys. Rehabil. Med. 2021; 57: 246-253https://doi.org/10.23736/S1973-9087.21.06692-2
- Effects of whole-body vibration training in patients with multiple sclerosis: a systematic review.Neurología. (English. Edition). 2018; 33: 534-548https://doi.org/10.1016/j.nrl.2016.04.007
Article info
Publication history
Published online: December 08, 2022
Accepted:
December 7,
2022
Received in revised form:
November 18,
2022
Received:
September 14,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
