Multiple Sclerosis (MS) & Occupational Therapy

If you’re seeking a multiple sclerosis therapist (especially an occupational therapy professional), we want you to be as informed as possible so we can truly partner to create the best course of treatment for YOU.

In occupational therapy, we tend to work from “menus” of evidence-based assessments and treatments. This gives us the flexibility to meet the specific needs of each individual. Below, you’ll find the assessment and treatment options your therapist may use, along with the evidence supporting them.

At the bottom of this page, you’ll find occupational therapists near you who specialize in addressing multiple sclerosis.

Members of the OT Potential Club can login for detailed clinical decision support on this diagnosis, including a comprehensive assessment search, goal bank, treatment info, handouts, a community forum and more.

Please note that this page is for educational purposes and does not substitute advice from your medical provider.

A quick note on why to pursue occupational therapy for Multiple Sclerosis

Rehabilitation—including occupational therapy—can help improve your quality of life when living with multiple sclerosis. Occupational therapy practitioners support individuals throughout the MS journey, from early diagnosis to long-term disease management. Early and ongoing rehabilitation can help individuals with MS adapt to changes in symptoms, develop effective self-management strategies, and maintain participation in the activities that matter most to them.

Multiple Sclerosis (MS) remains the leading cause of non-traumatic disability in adults aged 18–65. Occupational therapy practitioners are trained to address many of the challenges people with MS face in everyday life.

Therapist-recommended assessments for stroke rehab

Because MS can affect physical function, cognition, vision, fatigue levels, and other areas of daily life, you’ll notice that an OT multiple sclerosis evaluation focuses on multiple areas to provide a holistic understanding of your current therapy needs. 

In addition to informing treatment at the beginning of your therapy journey, assessments provide a point of comparison to track your progress and response to treatment over time. (Without an accurate and thorough baseline, it can be hard to tell how much the interventions are helping!) As such, your therapist may perform certain assessments at various intervals over the course of therapy.

Possible Assessments for Stroke Rehabilitation

Functional Capacity and Activities of Daily Living

• COPM
• Activity Card Sort
• Barthel Index for Activities of Daily Living (BI)
• Functional Independence Measure (FIM)
• Expanded Disability Status Scale (EDSS)
• MS Quality of Life 54 (MSQOL 54)
• Neurobehavioral Functioning Inventory (NFI)
• 10-Meter Walk Test (10MWT)
• 6-Minute Walk Test (6MWT)
• Multiple Sclerosis Impact Scale

Coordination

• 9-Hole Peg Test
• Box and Block Test (BBT)

Balance and Mobility

• Berg Balance Scale
• Timed Up and Go Test (TUG)
• Activities Specific Balance Scale

Sensation

• Sensation Screen
• Semmes Weinstein
• Proprioception and kinesthesia testing

Spasticity

• Modified Ashworth Scale (MAS)

Vision

• Oculomotor testing (including ocular alignment, convergence, and saccades)

Visual Tracking

• Visual field testing – BiVaBa Campimeter
• Visual Perceptual Testing
• Hooper Visual Organization Test
• MVPT-3

Strength

• MMT
• Dynamometer
• Pinch Gauge

Cognition

• Trail Making Test A and B
• Paced Auditory Serial Addition Test

Fatigue

• MFIS

Caregiver Support

• Caregiver Strain Scale (CSI)

Setting occupational therapy goals for multiple sclerosis

Therapy works best when there is buy-in from the patient. It is important that you work with your therapist to set treatment goals that truly reflect what’s important to you.

Goals may focus on areas such as activities of daily living, strength and coordination, pain and fatigue management, visual skills, self-management skills, coping skills, or social participation, among others.

Occupational Therapy Treatment Interventions for multiple sclerosis

After a thorough evaluation and goal-setting process, it is time to start making progress. Below are some broad areas of treatment intervention that can be implemented as part of a holistic therapy program. 

Occupational therapists take a unique approach, considering intervention at the person, environment, and occupational level.

Multidisciplinary approaches^1,2

Physiotherapy

• Individualized problem solving³
• Pelvic floor training⁴

Physical Activity

• Exercise therapy^5-10
• Resistance training^11,12
• High intensity interval training¹³
• Aerobic aquatic exercise¹⁴

Telerehabilitation

• Web-based exercise programs¹⁵
• Teletherapy physical rehabilitation interventions¹⁶

Cognitive and psychological interventions

• Memory Rehabilitation¹⁷
• Cognitive behavioral therapy^10,18-20
• Mindfulness interventions^20,21
• Group-based stress management interventions²¹
• Self-management interventions²²

Mind body interventions⁹

Fatigue management

• Energy conservation²
• Exercise²³
• Endurance and resistance training¹
• OT Fatigue management programs²⁴

Modalities

• Robot assisted gait training²⁵
• Virtual reality training²⁶
• Electrical stimulation
  • Transcutaneous electrical nerve stimulation (TENS)^27,28
  • Functional electrical stimulation (FES)²⁹
  • Neuromuscular electric al stimulation (NMES)⁴
• Respiratory training
• Manual stretches²⁹
• Nutritional and dietary supplements

Patient Education³⁰

• Vocational rehabilitation³¹
• Employment adaptations and support³²

Choosing an occupational therapist for MS rehabilitation

If you are looking for an occupational therapy professional near you to help address multiple sclerosis symptoms, you can use the OT Near Me Directory below. We’ve highlighted the professionals who have tagged “multiple sclerosis” as a focus area. 

Conclusion

Hopefully this article helped you understand what therapy for multiple sclerosis entails.

This article is updated regularly based on newly released research. If you have any research you would like us to consider, please drop it in the comments. 

Therapists who would like more detailed information on multiple sclerosis rehabilitation best practices can join us as members of the OT Potential Club.

Courses on OT and Multiple Sclerosis

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References

Here’s the science that backs the assessment and treatment outlined above. 

1. Amatya B, Khan F, Galea M. Rehabilitation for people with multiple sclerosis: an overview of Cochrane Reviews. Cochrane Library. 2019.
2. Khan F, Amatya B. Rehabilitation in Multiple Sclerosis: A Systematic Review of Systematic Reviews. Arch Phys Med Rehabil. 2017.
3. Paltamaa J, Sjögren T, Peurala SH, Heinonen A. Effects of physiotherapy interventions on balance in multiple sclerosis: A systematic review and meta-analysis of randomized controlled trials. Journal of Rehabilitation Medicine. 2012.
4. Block V, Rivera M, Melnick M, Allen DD. Do Physical Therapy Interventions Affect Urinary Incontinence and Quality of Life in People with Multiple Sclerosis?: An Evidence-Based Review. International Journal of MS Care. 2015.
5. Demaneuf T, Aitken Z, Karahalios A, et al. Effectiveness of Exercise Interventions for Pain Reduction in People With Multiple Sclerosis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Archives of Physical Medicine and Rehabilitation. 2019.
6. Ewanchuk BW, Gharagozloo M, Peelen E, Pilutti LA. Exploring the role of physical activity and exercise for managing vascular comorbidities in people with multiple sclerosis: A scoping review. Multiple Sclerosis and Related Disorders. 2018.
7. Heine M, Port I van de, Rietberg MB, Wegen EE van, Kwakkel G. Exercise therapy for fatigue in multiple sclerosis. Cochrane Library. 2015.
8. Kuspinar A, Rodriguez AM, Mayo NE. The effects of clinical interventions on health-related quality of life in multiple sclerosis: a meta-analysis. Mult Scler. 2012.
9. Momsen AMH, Ørtenblad L, Maribo T. Effective rehabilitation interventions and participation among people with multiple sclerosis: An overview of reviews. Annals of Physical and Rehabilitation Medicine. 2022.
10. Yu CH, Mathiowetz V. Systematic Review of Occupational Therapy–Related Interventions for People With Multiple Sclerosis: Part 2. Impairment. The American Journal of Occupational Therapy. 2014.
11. Manca A, Dvir Z, Deriu F. Meta-analytic and Scoping Study on Strength Training in People With Multiple Sclerosis. The Journal of Strength & Conditioning Research. 2019.
12. Jørgensen MLK, Dalgas U, Wens I, Hvid LG. Muscle strength and power in persons with multiple sclerosis – A systematic review and meta-analysis. Journal of the Neurological Sciences. 2017.
13. Campbell E, Coulter EH, Paul L. High intensity interval training for people with multiple sclerosis: A systematic review. Multiple Sclerosis and Related Disorders. 2018.
14. Corvillo I, Varela E, Armijo F, Alvarez-Badillo A, Armijo O, Maraver F. Efficacy of aquatic therapy for multiple sclerosis: a systematic review. Eur J Phys Rehabil Med. 2017.
15. Dennett R, Gunn H, Freeman JA. Effectiveness of and User Experience With Web-Based Interventions in Increasing Physical Activity Levels in People With Multiple Sclerosis: A Systematic Review. Physical Therapy. 2018.
16. Rintala A, Hakala S, Paltamaa J, Heinonen A, Karvanen J, Sjögren T. Effectiveness of technology-based distance physical rehabilitation interventions on physical activity and walking in multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials. 2016.
17. das Nair R, Martin KJ, Lincoln NB. Memory rehabilitation for people with multiple sclerosis. Cochrane Library. 2016.
18. Chalah MA, Ayache SS. Cognitive behavioral therapies and multiple sclerosis fatigue: A review of literature. Journal of Clinical Neuroscience. 2018.
19. Goverover Y, Chiaravalloti ND, O’Brien AR, DeLuca J. Evidenced-Based Cognitive Rehabilitation for Persons With Multiple Sclerosis: An Updated Review of the Literature From 2007 to 2016. Archives of Physical Medicine and Rehabilitation. 2018.
20. Phyo AZZ, Demaneuf T, De Livera AM, et al. The Efficacy of Psychological Interventions for Managing Fatigue in People With Multiple Sclerosis: A Systematic Review and Meta-Analysis. Front Neurol. 2018.
21. Taylor P, Dorstyn DS, Prior E. Stress management interventions for multiple sclerosis: A meta-analysis of randomized controlled trials. J Health Psychol. 2020.
22. Kidd T, Carey N, Mold F, et al. A systematic review of the effectiveness of self-management interventions in people with multiple sclerosis at improving depression, anxiety and quality of life. PLOS ONE. 2017.
23. Asano M, Finlayson ML. Meta-Analysis of Three Different Types of Fatigue Management Interventions for People with Multiple Sclerosis: Exercise, Education, and Medication. Multiple Sclerosis International. 2014.
24. Salomè A, Sasso D’Elia T, Franchini G, Santilli V, Paolucci T. Occupational Therapy in Fatigue Management in Multiple Sclerosis: An Umbrella Review. Multiple Sclerosis International. 2019.
25. Etoom M, Khraiwesh Y, Lena F, et al. Effectiveness of Physiotherapy Interventions on Spasticity in People With Multiple Sclerosis: A Systematic Review and Meta-Analysis. American Journal of Physical Medicine & Rehabilitation. 2018.
26. Maggio MG, Russo M, Cuzzola MF, et al. Virtual reality in multiple sclerosis rehabilitation: A review on cognitive and motor outcomes. Journal of Clinical Neuroscience. 2019.
27. Miller L, McFadyen A, Lord AC, et al. Functional Electrical Stimulation for Foot Drop in Multiple Sclerosis: A Systematic Review and Meta-Analysis of the Effect on Gait Speed. Archives of Physical Medicine and Rehabilitation. 2017.
28. Sawant A, Dadurka K, Overend T, Kremenchutzky M. Systematic review of efficacy of TENS for management of central pain in people with multiple sclerosis. Multiple Sclerosis and Related Disorders. 2015.
29. Campbell E, Coulter EH, Mattison PG, Miller L, McFadyen A, Paul L. Physiotherapy Rehabilitation for People With Progressive Multiple Sclerosis: A Systematic Review. Archives of Physical Medicine and Rehabilitation. 2016.
30. Wendebourg MJ, Pöttgen J, Giordano A, Finlayson M, Heesen C, Köpke S. Patient education for fatigue in people with multiple sclerosis. Cochrane Library. 2019.
31. Sweetland J, Howse E, Playford ED. A systematic review of research undertaken in vocational rehabilitation for people with multiple sclerosis. Disabil Rehabil. 2012.
32. Dorstyn DS, Roberts RM, Murphy G, Haub R. Employment and multiple sclerosis: A meta-analytic review of psychological correlates. J Health Psychol. 2019.
33. Zhang, X. N., Liang, Z. D., Li, M. D. 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. 2024.
34. Hedström AK, Olsson T, Piehl F, et al. Beneficial impact of physical activity on multiple sclerosis disability progression. Journal of Neurology, Neurosurgery & Psychiatry. 2026.

OT Potential does not endorse any treatments, procedures, products, or therapists referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking medical advice should consult their medical provider.

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