Dr Kathy Zackowski Identifies the Importance, Promising Strategies of MS Rehabilitation

Kathy Zackowski, PhD, associate vice president of the National Multiple Sclerosis (MS) Society, discusses the importance of MS rehabilitation and lists several successful strategies.

MS rehabilitation was further explored at the Americas Committee for Treatment and Research in MS (ACTRIMS) Forum 2024 on March 2 during the session, "Rehabilitation Without Borders."

Transcript

What are the key mechanisms involved in MS rehabilitation?

The goal of rehabilitation is to allow people to do what they want to do. The goal is really to determine what's missing; what are the elements that we need to address to allow people to do that?

We know that there are key biologic mechanisms that drive symptoms and progression. One goal of rehab research is really to identify, what are those particular elements that we can change to allow someone to be more functional? This is complicated because MS has a variety, a large variety, of symptoms, as well as comorbidities that can be controlled. So, weight, smoking, vitamin D, we know all of those things can affect not only the risk of MS, but also progression.

What specific rehabilitation strategies have shown promise in improving the quality of life for patients with MS?

There's a wide variety. The first thing that comes to mind is exercise. There's evidence to suggest that aerobic exercise is good for some people, resistance training is better for some people, and some combination is good for some people.

It's important to recognize that people with different levels of ability can do different types of exercise. So, we need to learn to adapt exercise so that everyone at every level of ability with MS can participate in exercise, and that has been shown to really improve quality of life.

Other things that come to mind are even just walking. There's a study just covering targeted walking, and what they did over 10 weeks is they had people walk on a treadmill. They found that not only were there changes in quality of life, but there were neuroprotective changes, so biologic changes that could be an incentive to people for why exercising is so important.

Fatigue is a really important symptom. As well as improving quality of life, balance exercises have been shown to be really helpful, as well as cognitive behavioral therapy, and even the combination of balance exercises and cognitive behavioral therapy.

Cognitive behavioral therapy addresses these pathways between what your thoughts are, what your feelings are, and what your behaviors are, and really being able to address that through these noninvasive therapies. It has been shown to be really helpful to people's quality of life.

Last but not least, really thinking about mindfulness-based interventions or self-management strategies, things that we can do and think about that decreases our stress, or helps us cope with the stress of our life. Because there's such a variety of interventions, it's really important for MS patients to see an expert, so there are a variety of rehabilitation experts, but those experts really can address which intervention is going to be most effective.