The rehabilitation of progressive MS whether primary, secondary, or progressive with a relapsing course provides its own set of unique challenges. Not only must there be an emphasis on restoring lost function but there must be an emphasis on maintaining or preventing loss of function despite a progressive disease. Initially the disease must be managed. To date we know no statistically significant pharmaceutical which will control the disease and is universally accepted. Nonetheless much can be done to help the person with progressive MS apart from the use of immunomodulation.
Secondary symptoms follow from a lack of success in the management of the primary problems.
The World Health Organisation has separated the problems of chronic disease into three different categories Impairement Disability Handicap Impairment is a manifestation of the abnormalities seen on the neurological examination. Disability includes the problems in activities of daily living that result from the impairments. Handicap becomes the tertiary symptoms mentioned above with difficulties in life resultant from the problems of disability and impairment. No matter how one separates the problems, to manage progressive MS one must treat those that can be treated and not look back at the ones that are impossible to manage. By going after the treatable processes the secondary and tertiary problems become less and the frustration also is less.