Rehabilitation principles for patients with multiple sclerosis.

The purpose of this review was to discuss some newer rehabilitation techniques and their applications in MS. There are a number of other rehabilitation problems--bladder dysfunction, cognitive impairment, and pain, to name a few--that are important to address in the rehabilitation of a patient with MS, but that were not covered in this review. I would like to stress the principle that we need to adapt rehabilitation strategies to a progressive neurologic disease with an uncertain future course. That means we need to "overrehabilitate" MS patients with exacerbating and remitting unstable disease. As an example of what this means, consider a patient who has an EDSS of 4.5 and has a certain level of function. Suppose the patient receives a rehabilitative course and functions well. However the patient may have an exacerbation and become worse, going to an EDSS of 6.5, which may or may not improve. During this period, this patient needs to be able to function at his or her more impaired level. Therefore, it is important to train patients in therapeutic strategies they can use if they become temporarily worse. We need to remember that all organ system problems exist in a singular patient. Consequently, we must coordinate all of the treatments together, because the whole system must work for the patient as a whole.