MS and Physical Medicine & Rehabilitation
Multiple sclerosis is a chronic autoimmune disease of the central nervous system in which the immune system attacks myelin — the protective sheath surrounding nerve fibers — causing demyelination and axonal injury throughout the brain and spinal cord. The resulting neurological deficits vary widely depending on lesion location and accumulation over time.
Physiatry plays a critical role in MS care. While neurologists manage disease-modifying therapies to slow progression, physiatrists address the functional consequences of neurological damage — maximizing what patients can do despite their disease. Rehabilitation does not reverse MS, but it demonstrably reduces disability, improves quality of life, and slows functional decline.
Common Functional Impairments in MS
- Fatigue — the most common and disabling MS symptom, often disproportionate to visible disability
- Spasticity — muscle stiffness and spasms that impair walking, positioning, and comfort
- Gait and balance deficits — increased fall risk, foot drop, and reduced walking endurance
- Upper extremity weakness and coordination — limiting fine motor tasks and self-care
- Neuropathic pain — dysesthesia, trigeminal neuralgia, and Lhermitte's sign
- Bladder and bowel dysfunction — neurogenic bladder requiring structured management
- Cognitive impairment — processing speed, memory, and executive function
- Heat sensitivity — temporary worsening of symptoms with elevated body temperature (Uhthoff phenomenon)
Rehabilitation Approach at CHLMD
MS rehabilitation at CHLMD is individualized to the patient's current functional status, disease phase (relapsing-remitting, secondary progressive, or primary progressive), and specific symptom burden. Therapeutic exercise — carefully progressed and heat-monitored for sensitive patients — is the most evidence-supported intervention for MS fatigue and walking function. Gait and balance training reduces fall risk. Spasticity management combines stretching, positioning, pharmacological agents, and targeted injection therapy for focal spasticity unresponsive to oral medications.
Fatigue management strategies — energy conservation, activity pacing, aerobic conditioning — are tailored to each patient. Neuropathic pain is treated with mechanism-specific pharmacological and rehabilitative approaches. Dr. Lichtblau coordinates with the patient's neurologist to ensure physiatric interventions complement disease-modifying therapy.
Adapting Care Through Disease Progression
MS is dynamic — rehabilitation must evolve with the disease. CHLMD provides ongoing physiatric management that adjusts exercise prescription, spasticity management, assistive device recommendations, and home modification guidance as the patient's functional status changes. The goal is always to maintain the highest possible level of independence and participation in meaningful activities.
