Cover Story: The Benefits of Physical, Speech, and Occupational Therapies

The Benefits of Physical, Speech, and Occupational Therapies

By Tom Garry
Reviewed by Barry A. Hendin, MD

Multiple sclerosis has a highly individualized, sometimes life-altering impact on each person it affects. Fortunately, the same can be true of physical therapy, speech therapy, and occupational therapy when people with MS partner with therapists in those professions.

“There is always something you can do,” says physical therapist Mandy Rohrig, DPT, MSCS, and member of MSAA’s Healthcare Advisory Council (HAC). She explains that no matter the nature of a person’s MS, working with a therapist can identify ways to adapt to the condition and live your best possible life. This article will examine what physical therapy (PT), speech therapy (ST), and occupational therapy (OT) entail, the role they play in the management of MS, and how people with MS can make effective use of the therapies to enhance their quality of life.

Please note that while mental health counseling or therapy can also offer considerable benefits, it is not addressed in this article, which focuses on therapies that address the physical manifestations of multiple sclerosis. For information on mental wellness, please visit mymsaa.org for webinars, podcasts, and articles on this topic.

Physical Therapy

The American Physical Therapy Association (APTA) explains, “Physical therapy is treatment provided by a physical therapist or physical therapist assistant that helps people improve their movement and physical function, manage pain and other chronic conditions, and recover from and prevent injury and chronic disease.” APTA adds that physical therapists “examine, diagnose, and treat movement dysfunction.¹

After earning a bachelor’s degree, a person aspiring to a career in the profession must complete a Doctor of Physical Therapy (DPT) program accredited by the Commission on Accreditation in Physical Therapy Education and pass a state licensure exam. DPT programs typically are three years in length.² Some physical therapists – particularly those who have been practicing for many years – do not have a doctoral degree, but meet their state’s licensing requirements for the profession.³

The physical therapist’s role in treating a person with MS depends on the challenges the person is facing, but Dr. Rohrig notes that walking difficulties and balance issues are two of the main reasons people with MS receive physical therapy.

Speech Therapy

Turning to speech therapy, the American Speech-Language-Hearing Association notes, “Speech-language pathologists (SLPs) work to prevent, assess, diagnose, and treat speech, language, social communication, cognitive-communication, and swallowing disorders in children and adults.”⁴ Those specialists, often referred to as speech therapists, must earn a master’s degree from a program accredited by the Council on Academic Accreditation in Audiology and Speech-Language Pathology, complete a clinical fellowship,⁵ and meet their state’s licensure requirements.

Sherry Perucho, DHA, MA, CCC-SLP, CBIST, says that communication and swallowing challenges are among the main reasons people with MS seek care from her fellow speech-language pathologists.

Occupational Therapy

The American Occupational Therapy Association (AOTA) states, “Occupational therapy enables people of all ages to participate in daily living,” adding that occupational therapists “focus on the things you want and need to do in your daily life. Occupational therapy intervention uses everyday life activities (occupations) to promote health, well-being, and your ability to participate in the important activities in your life.”⁶ A master’s or doctoral degree is required to practice as an occupational therapist,⁷ and state licensure is also required.

Shaina Meyer, MS, EdD, MSCS, is an occupational therapist with extensive clinical experience in MS and a member of MSAA’s Healthcare Advisory Council (HAC). She explains that people with multiple sclerosis receive OT for issues ranging from fine motor skills to fatigue management.

Get Ready, Get Set, and Go to Therapy!

A common theme voiced by the experts interviewed for this article is that earlier interaction with a therapist, typically translates into greater benefits for a person with MS.

“Many people with MS wait until they experience significant difficulties before they seek speech therapy support. Ideally, I’d like to see individuals proactively, even before noticeable speech or swallowing changes occur,” says Dr. Perucho, a speech-language pathologist and clinical manager at the Nevada Community Enrichment Center, a comprehensive rehabilitation center for people with neurological conditions, located in Las Vegas, Nevada.

Dr. Sherry Perucho

“People with MS should know they have options. They don’t have to struggle alone.”
— Sherry Perucho, DHA, MA, CCC-SLP, CBIST

She continues, “Clinicians and patients should be aware of early signs, such as increased effort to speak clearly or be understood, subtle voice fatigue or changes in volume, mild coughing or throat clearing during meals, and difficulty with multitasking or processing conversations. Identifying these issues early allows for preventative strategies that help individuals maintain their function longer and adapt to changes more effectively.” Dr. Perucho notes that she is seeing a welcome trend toward earlier referral as the multidisciplinary model of comprehensive care becomes more widely adopted by MS providers.

Even with a referral, however, some people with MS can be reluctant to make an appointment with a therapist for a very understandable reason, according to Dr. Rohrig. She states, “Often times, particularly in those first weeks and months after receiving a diagnosis of MS, people are faced with a lot of decisions related to medications, related to employment, related to their social relationships and overall life, and I think physical therapy and other types of therapy can become de-prioritized when dealing with that lengthy to-do list.”

Dr. Rohrig is a physical therapist and Certified Multiple Sclerosis Specialist, serving as Senior Programs Consultant for Can Do MS. She notes that insurance coverage and financial considerations can also be barriers. Dr. Rohrig adds that scheduling an appointment with a therapist should not become an obligation for people with MS, but rather should be seen as a service available to them once they are ready for it.

Ms. Meyer is an occupational therapist and Certified Multiple Sclerosis Specialist who teaches occupational therapy and health policy as a clinical instructor at the University of Arkansas. She says that when ready to work with a therapist, taking some time before the first meeting to think about the challenges one is experiencing in the course of daily life, along with one’s specific goals of therapy, can be very helpful.

Ms. Meyer explains, “When we meet with a person with MS, we want to know, ‘What is most impactful to you?’ We’re going to focus our attention on that issue or activity, looking at underlying causes, contributing factors, and potential strategies to address it.”

While sooner is better than later, and taking time to prepare beforehand, can make for a more productive intake session, the most important step people with MS can take with regard to therapy is the first step: making and going to that initial appointment.

What Happens at the First Session?

Ms. Meyer explains that when she was in clinical practice, her typical intake visit for a person with MS was one-hour long. “The first 15 minutes were devoted to reviewing what I had learned about the person from the medical information I had received prior to the meeting and asking clarifying questions to dig deeper into some details I needed about their routines or the roles they might fulfill in their day, like being a mother or a full-time office worker or somebody who plays pickleball twice a week.

“When we meet with a person with MS, we want to know, ‘What is most impactful to you?’ We’re going to focus our attention on that issue or activity, looking at underlying causes, contributing factors, and potential strategies to address it.”
– Shaina Meyer, MS, EdD, MSCS

“The next 30 minutes or so would involve assessments. During that time, I would assess skills that may be impacting function, including physical factors (such as strength), cognitive factors (like attention), and psychosocial factors (such as anxiety), while also considering how other variables, like fatigue and sensory changes, might complicate these skills. We would spend the last 10 to 15 minutes with me providing a summary of what I had observed and obtaining the person’s feedback or questions. Most importantly, we’d look at the person’s goals.”

She continues, “When I meet with people for an evaluation, the questions I ask include, ‘What matters most to you? When you think about your day and your roles, what motivates you? What inspires you to get up in the morning?’ It’s important to get those answers because they speak to the core of the person. From there, we can figure out together how to help them continue being successful in those areas.”

Dr. Rohrig and Dr. Perucho explain that the initial physical therapy and speech-pathology sessions for a patient with MS are similarly wide-ranging and focused on the patient’s priorities.

As with occupational therapy, the assessments performed during a physical therapy intake session focus on balance, strength, and range of motion, in addition to mobility, Dr. Rohrig says. She adds, “The first visit includes discussion of why the person has come to physical therapy and what they want to achieve from the time we spend together.”

In terms of speech therapy, Dr. Perucho says, “A comprehensive initial assessment includes a detailed evaluation of speech, swallowing, and cognitive-communication abilities. Speech assessment focuses on articulation, volume, breath support, and overall intelligibility. Swallowing evaluation involves observing the person while eating and drinking, and in some cases, instrumental studies like a Videofluoroscopic Swallow Study (VFSS) or Fiberoptic Endo-scopic Evaluation of Swallowing (FEES) may be recommended.” She adds that speech-pathology therapists receive extensive training in performing these safe, painless procedures.

Dr. Perucho continues, “Cognitive-communication assessment examines attention, memory, executive function skills, language, and processing speed to identify any challenges affecting daily interactions. Additionally, we discuss the functional impact of these symptoms, exploring how they affect the person’s daily life. Based on the assessment, we set personalized goals tailored to what matters most to the individual, whether that’s improving speech clarity for work, ensuring safer swallowing, or developing strategies to manage cognitive fatigue.”

The information gathered at the intake sessions often provides clues to underlying problems that would not be immediately apparent without this clinical equivalent of detective work. Ms. Meyer explains, “Let’s say a woman tells me, ‘When I’m cooking a meal, I’m dropping lots of things.’ She assumes that this is because she is having sensory changes or hand weakness. However, the evaluation may show that there is not a sensory problem and that her grip strength is good.

“Further assessment may reveal cognitive changes. If so, one of the things we’re going to explore is whether doing too many things at once – having a conversation with someone or listening to the radio while she’s trying to cook – is putting too much demand on her brain, and that’s why she is dropping things. If that is the case, then the strategy isn’t to perform exercises to enhance grip strength, it’s to change how she completes that task and build skills to make her more successful at multi-tasking. However, that wouldn’t have been apparent if we had not thoroughly explored the situation.”

In keeping with that example, she explains that a therapist’s role involves formulating strategies and fashioning workarounds (strategies for managing a problem without fully resolving it) as well as having a patient perform specific exercises. “It’s more than just remediating or fixing something. It’s about changing habits and behaviors and routines,” Ms. Meyer adds.

Two Keys to Success: Realistic Expectations and Real Effort

An avid runner came to see Dr. Rohrig not long after being diagnosed with primary-progressive MS. “So much of his identity, his view of himself, was wrapped up in running,” she recalls. Now, the man who was accustomed to logging many miles over the road each week, had reached a figurative crossroads. “Like many people with MS, he had to decide whether he would stop pursuing an activity that he loved because he could no longer engage in it the way that he had before his symptoms emerged, or whether he would make adaptations that would allow him to continue running, albeit in a different way.

Exemplifying the grit of a long-distance runner, the man decided to keep going. “He knew that not only his identity but also his mental health and his physical well-being were related to running, and so he fit his routine to his abilities. He would run for a bit and then walk for a bit. It took more time, but he still got his miles in. To my mind, a ‘ralk star’ (run-walk star),” the physical therapist says.

“Regardless of your level of ability, move to the extent that you can, and use that movement to find joy in your life.”
– Mandy Rohrig, DPT, MSCS

Dr. Rohrig says that the man’s story is a testament not only to the strength and resilience of so many people with MS, but also to the importance of bringing realistic expectations to any form of therapy.
In some cases, the experts interviewed for this article say, patients come to therapy expecting a “cure” – the total elimination of a symptom or limitation – and view anything short of that as unacceptable and not worth the effort. Although therapsts pursue remediation whenever possible, a patient’s condition often means that the goal of therapy is not so much to restore function to a pre-diagnosis state, as it is to achieve incremental improvement or stop or slow further decline.

They add that while therapists owe patients their best assessment of what’s realistic, patients owe it to themselves to embrace what’s realistic and to make a real effort to pursue it as best they can.

According to Ms. Meyer, that pursuit of what’s possible needs to take place outside of therapy appointments as well as during those sessions. She explains that when she was providing patient care, “I felt very strongly about not seeing people for extended periods of time, because a big part of our model was building self-determination and self-advocacy with our interventions – teaching and training people how to do things themselves, rather than me just doing things to them or for them.”

The occupational therapist adds that while it can be challenging to find the right balance between direct care and patient education, some people may struggle to engage with exercises or strategies on their own, leading to reliance on the therapist and viewing therapy as just attending appointments.

Recognizing each person’s unique circumstances can help create a more collaborative approach where clients feel supported in taking charge of their progress. “We should be supporting people so that they are able to do [exercises] on their own. We should be removing barriers. So, if I’m teaching someone about an exercise program, I want to make sure that they can follow it with or without me, and that they have the tools and home or community environment they need to do it.”

Closing Thoughts from the Experts

While physical, speech, and occupational therapists are experts in their respective disciplines and can recommend interventions tailored to an individual’s specific needs, they can also develop an important perspective on “the big picture” by virtue of seeing many people with MS over the years. The three MS clinicians interviewed for this article drew on that perspective to offer some final thoughts to readers living with MS.

Dr. Rohrig says, “Keep moving! Movement gives people confidence and enables them to live their best life. So many people come to physical therapy thinking of all the things they can’t do. And whether they are walking or are using a wheelchair, they often are surprised to discover all of the things they can do. So regardless of your level of ability, move to the extent that you can, and use that movement to find joy in your life.”

Ms. Meyer offers, “I believe that everyone deserves to prioritize their health and wellness, but I understand that it can be challenging for different people based on their unique circumstances. It’s not about striving for perfection in diet, exercise, or sleep. Rather, it’s about making small, mindful choices that support our well-being, whether that’s nourishing our bodies, moving in ways that feel good, or finding moments of rest. Each of us is on our own journey, and every choice we make impacts our overall health, including our ability to cope with stress and anxiety. It’s all connected, and even small steps can lead to meaningful improvements.”

And Dr. Perucho concludes, “Remember that speech therapy and other forms of therapy aren’t just about fixing problems. With speech therapy, it’s about preserving communication, swallowing safety, and quality of life for as long as possible. Comparable goals apply in other forms of therapy, and the earlier we start, the more options we have. Above all, people with MS should know they have options. They don’t have to struggle alone.”

References

American Physical Therapy Association. The Physical Therapy Profession. Accessed February 25, 2025.
American Physical Therapy Association. Becoming a Physical Therapist. Accessed February 25, 2025.
American Physical Therapy Association. Transition DPT FAQs. Accessed February 25, 2025.
American Speech-Language-Hearing Association. Learn About the CSD Professions: Speech-Language Pathology. Accessed March 1, 2025.
American Speech-Language-Hearing Association. Speech-Language Pathology Pathway to Certification. Accessed March 1, 2025.
American Occupational Therapy Association. What Is Occupational Therapy? Accessed February 25, 2025.
American Occupational Therapy Association. Become an OT/OTA. Program admissions criteria and formats. Accessed February 25, 2025.