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Review Multiple Sclerosis Neurorehabilitation in Multiple Sclerosis – Resilience in Practice Jürg Kesselring Department of Neurology and Neurorehabilitation Rehabilitation Centre, Valens, Switzerland I n recent years, enormous strides have been made in increasing the range and efficacy of disease-modifying drugs available for the treatment of multiple sclerosis (MS) in its early and remitting stages, and more continue to emerge. Another equally important concept of successful treatment of MS is neurorehabilitation, which must be pursued alongside these medications. Key factors that contribute to the impact of neurorehabilitation include resilience and neuroplasticity. In the former, components such as nutrition, self-belief and physical activity provide a stronger response to the disease and improved responses to treatment. Neuroplasticity is the capacity of the brain to establish new neuronal networks after lesion damage has occurred and distant brain regions assume control of lost functions. In MS, it is vital that each patient is treated by a coordinated multidisciplinary team. This enables all aspects of the disease including problems with mobility, gait, bladder/bowel disturbances, fatigue and depression to be effectively treated. It is also important that the treating team adopts current best practice and provides internationally agreed standards of care. A further vital aspect of MS management is patient engagement, in which individuals are fully involved and are encouraged to strive and put effort into meeting treatment goals. In this approach, healthcare providers become motivators and patients need less intervention and consume fewer resources. Numerous interventions that promote neurorehabilitation are available, though evidence to support their use is limited by a lack of data from large randomised controlled trials. Combining interventions that promote neurorehabilitation with newer, more effective treatments creates a promising potential to substantially improve the outlook for patients at all stages of MS. Keywords Multiple sclerosis, resilience, neurorehabilitation, neuroplasticity Disclosure: Jürg Kesselring is a member of the European Neurological Review Editorial Board; he has nothing to disclose in relation to this article. There were no publication fees associated with the publication of this article. Acknowledgements: Medical writing assistance was provided by James Gilbart, Freelance Writer, and was supported by Touch Medical Media. Compliance with Ethics: This article involves a review of the literature and did not involve any studies with human or animal subjects performed by the author. Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. Received: 27 October 2016 Accepted: 5 January 2017 Citation: European Neurological Review, 2017;12(1):31–6 Corresponding Author: Jürg Kesselring, Head of the Department of Neurology and Neurorehabilitation Rehabilitation Centre Valens, CH-7317 Valens, Switzerland. E: juerg.kesselring@kliniken-valens.ch Approaches to managing multiple sclerosis (MS) are changing rapidly and are achieving markedly improved efficacy in inhibiting the disease process. 1–3 As a result, treatment goals have progressed beyond halting disability progression. The most apparent reason for these achievements is the increasing use of disease-modifying drugs (DMDs) and the emergence of new DMDs that are more effective than those previously available. Despite these advances in DMDs and symptomatic therapies, there remains a need for comprehensive rehabilitation interventions in order to reduce disease symptoms, and to achieve maximal independence and quality of life, particularly in patients with progressive disease. 4 When initiating a neurorehabilitation programme, it is important to appreciate the value of maintaining resilience and neuroplasticity in MS patients and to understand the approaches that can encourage these factors and promote neurorehabilitation. Whilst DMDs can limit the occurrence of relapses and inhibit or delay disease progression, those developed so far have limited capacity to ameliorate all the existing disabilities that patients may have, particularly those with progressive disease. It is critical therefore that healthcare providers, who treat patients with MS, are aware of the potential of physical and cognitive therapies, and the benefits that neurorehabilitation can provide for the patient, especially when combined with DMD therapy. This review therefore considers the mechanism of action of neurorehabilitation in MS and interventions that can promote it in particular with respect to resilience and neuroplasticity. Resilience in multiple sclerosis In neurological conditions including MS, the concept of resilience is important in terms of impact of the disease and response to treatment. It is difficult to give a concise definition of resilience in the context of MS but it is related to psychological adaptation, social connection, life meaning, planning and physical wellness. 5 The concept of resilience comprises physical, mental and emotional components including good nutrition, rest and self-belief (see Figure 1). Without such activity and participation, there is insufficient neuronal stimulation, diminishing or eliminating the prospect of recovery. Patients must be encouraged to develop resilience in order to maximise their potential for regaining some degree of their lost physical abilities. In a study of MS patients, the effect of occupational therapy on resilience was assessed. 6 The findings indicated that resilience has an important role in terms of functional recovery and maintenance. The authors concluded that the use of occupational therapy within multidisciplinary TOU CH MED ICA L MEDIA 31