The others also need to sell their goals and methods. The selling is to the patient but also to the other members of the team. Obviously, the mainstay of the rehabilitative management of MS remains the physical modalities and conditioning associated with the sciences of rehabilitation. Whether that is lower extremity stretching, upper extremity coordination exercises, speech and swallowing instruction, stress management, or making a meal - a consistency and positive influence to the instruction is essential. In today's world time is money and if medication allows for increased efficiency and effectiveness, its value is obvious.
Surgery is usually a last resort in rehabilitation.
Tendonotomies and decubitus surgery are too frequently necessary to compensate for the lack of aggressive rehabilitation in an individual patient. It is now accepted by most health care providers that MS is a rehabilitative neurologic disease. What is not well understood by most is the methodology of rehabilitation. Decisions as seemingly elementary as where the rehabilitation should take place and who should be involved are not simple. Studies of the decision making progress and clinical pathways, are almost impossible because of the extreme variability of not only the disease but even the climatic conditions affecting the individual.