Treatment for multiple sclerosis (MS) has evolved considerably over the recent decades. Alongside pharmacological therapy, there is growing recognition that rehabilitation is an important pillar of care from the very start. Research shows that a timely, multidisciplinary approach can already be meaningful and effective early in the disease course.

People with MS often experience several symptoms simultaneously, with fatigue, mobility problems, cognitive difficulties and pain being the most common limitations in daily functioning. Because symptoms tend to co-occur and fluctuate, rehabilitation works best when it takes a broad approach focused on activity and participation rather than targeting a single symptom in isolation.

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Key elements of rehabilitation

Various factors influence functioning from the early stages of the disease. Rehabilitation therefore begins with what people with MS want and are able to do in their daily lives, combining recovery, compensation and self-management.

Where possible, the focus is on improving or maintaining functions such as strength, endurance, balance, mobility, attention, and memory strategies. Targeted training can not only influence symptoms, but also contribute to better movement, increased confidence in one’s abilities, and greater day-to-day energy. Recent work also indicates that targeted training can activate neuroplasticity (including functional and structural connectivity), enabling the nervous system to adapt more effectively. This supports a proactive approach that can complement pharmacological treatment.

Equally important is learning to manage limitations so that activities can or continue to be carried out successfully: energy management, assistive devices, task and environmental adaptations, time-outs, planning, sensory-stimulus management, safe movement strategies, or redistributing tasks at home. Compensation is not “giving up”, but a way of protecting roles and quality of life.

In practice, rehabilitation is rarely a matter of choosing between restoring or compensating. It is usually a combination that enables a good quality of life.

Self-management strengthens the skills needed to regulate health and activity, recognise warning signs, and make timely adjustments between consultations. This supports adherence to therapy and helps prevent deterioration.

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What works (and for whom)?

Given the wide range of symptoms and limitations in MS, a multidisciplinary approach is generally the most effective: physical training, occupational therapy, cognitive interventions and psychological support, supplemented where necessary by speech therapy, dietetics and social guidance. Involving a partner or family members helps maintain strategies and recognise overburdening in time.

There is strong to moderate evidence that targeted physical training reduces fatigue and improves mobility, strength, balance and endurance. This applies to people with mild to moderate disability, and benefits have also been described in progressive forms. Training may additionally contribute to favourable changes in brain connectivity.

Cognitive interventions show improvements in memory, strategy use and daily functioning, particularly when transfer to everyday life and the person’s own context is explicitly included.

Therapy focused on daily functioning and life roles with clear goals, energy management and achievable home exercises supports independence and job retention. Gains arise not only from training, but also from strengthening compensatory strategies and self-management early on. Work-oriented rehabilitation can help prevent job loss.

Telerehabilitation increases adherence and continuity, with virtual training and functional electrical stimulation as useful additions -- especially for people who find it difficult to attend a rehabilitation setting (regularly).

Functional gains are possible even as MS progresses. Improvements often persist for weeks to months. Rehabilitation is therefore not a “last resort”, but a continuous, goal-oriented process that adapts to the person’s needs and stage of the disease.

Goals are based on what matters to the individual for their daily functioning and participation, and are set in a time-bound and dynamic way. Priorities can shift quickly (for example, maintaining energy balance at work), making a cyclical process of assessment, treatment,  measurement, and adjustment essential.

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Conclusion

Rehabilitation is an essential component of MS care from the moment of diagnosis. It is a flexible process that combines recovery and compensation, adapting continuously to what a person needs. Early referral to a specialised rehabilitation team increases the likelihood of maintaining an active and high-quality lifestyle, whatever the course of the disease.

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Professor Daphne Kos, KU Leuven & MS Center Melsbroek

Professor Peter Feys, UHasselt

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References

Amatya, B., Khan, F., & Galea, M. (2019). Rehabilitation for people with multiple sclerosis: An overview of Cochrane Reviews. Cochrane Database of Systematic Reviews, 2019(1), CD012732. https://doi.org/10.1002/14651858.CD012732.pub2.

Dalgas, U., Hvid, L.G. (2025). Multiple Sclerosis. In: Nielsen, J.B., Frisk, R.F., Lorentzen, J., Larsen, L.H. (eds) Neuroplasticity-based Neurorehabilitation. Springer, Cham. https://doi.org/10.1007/978-3-031-81120-3_20.

Kos D, Boers A, O'Meara C, Bekkering GE, De Coninck L, Koen M, Freeman J, Hynes SM, Eijssen IC. Occupational therapy for multiple sclerosis. Cochrane Database Syst Rev. 2026 Jan 20;1(1):CD015371. doi: 10.1002/14651858.CD015371.pub2.

Hedeager Momsen A-M, Ørtenblad L, Maribo T. Effective rehabilitation interventions and participation among people with multiple sclerosis: An overview of reviews. Ann Phys Rehabil Med. 2022;65(1):101529. doi:10.1016/j.rehab.2021.101529.

Iodice R, Aceto G, Ruggiero L, Cassano E, Manganelli F, Dubbioso R. A review of current rehabilitation practices and their benefits in patients with multiple sclerosis. Multiple Sclerosis and Related Disorders 2023;69:104460. doi:10.1016/j.msard.2022.104460. 

European Multiple Sclerosis Platform (EMSP). (2025). Impact van MS-symptomen in België: Factsheet.https://ms-sep.be/wp-content/uploads/2025/05/IMSS_Factsheet-Nl.pdf.