• Patients who present with any functional limitation should have an initial evaluation and appropriate management.

• Assessment for rehabilitation services should be considered early in the disease when behavioral and lifestyle changes may be easier to implement.

• The complex interaction of motor, sensory, cognitive, functional, and affective impairments in an unpredictable, progressive, and fluctuating disease such as MS requires periodic reassessment, monitoring, and rehabilitative interventions.

• The frequency, intensity, and setting of the rehabilitative intervention must be based on individual needs. Some complex needs are best met in an interdisciplinary, inpatient setting, while other needs are best met at home or in outpatient settings. The healthcare team should determine the most appropriate setting. Whenever possible, patients should be seen by rehabilitation therapists who are familiar with neurological degenerative disorders.

• Research and professional experience support the use of rehabilitative interventions—including exercise, functional training, equipment prescription, provision of assistive technology, orthotics prescription, teaching of compensatory strategies, caregiver/family support and education, counseling, and referral to community resources—in concert with other medical interventions, for the following impairments in MS:

• mobility impairments (i.e. impaired strength, gait, balance, range of motion, co-ordination, tone, and endurance);

• fatigue;

• pain;

• dysphagia;

• bladder/bowel dysfunction;

• decreased independence in ADL;

• impaired communication;

• diminished quality of life (often caused by inability to work, engage in leisure activities, and/or to pursue usual life roles);

• depression and other affective disorders; and • cognitive dysfunction.

• Research-appropriate assessments and outcome measures must be applied periodically to establish and revise goals, identify the need for treatment modification, and measure the results of the intervention.

• Known complications of MS such as contractures, disuse atrophy, decubiti, risk of falls, and increased dependence may be reduced or prevented by specific rehabilitative interventions.

• In a fluctuating and progressive disease, maintenance of function, optimal participation, and quality of life are essential outcomes.

• Maintenance therapy includes rehabilitation interventions designed to preserve current status of ADL, safety, mobility, and quality of life, and to reduce the rate of deterioration and development of complications.

• A thorough assessment for wheelchairs, positioning devices, other durable medical equipment (DME), and environmental modification by rehabilitation professionals is recommended, and will result in the use of the most appropriate equipment. • Regular and systematic communication between the referring healthcare provider and rehabilitation professionals will facilitate comprehensive and quality care.

• Third-party payers should cover appropriate and individualized restorative and maintenance rehabilitation services for people with MS.