Recent advances in multiple sclerosis neurorehabilitation

Advances in multiple sclerosis (MS) diagnosis and treatment have altered disease trajectories, yet many people with MS (pwMS) continue to experience complex symptom burden, functional limitations, and reduced quality of life (QoL). This review summarizes recent developments in neurorehabilitation, focusing on screening and assessment, intervention delivery, and outcome or impact evaluation across symptoms and disability domains.

Research evidence supports routine, multidimensional screening that goes beyond assessing symptom severity to capture functional limitations, participation restrictions, and social determinants of health (SDoH). Digital technologies, including wearables, remote monitoring, and artificial intelligence-assisted assessments, offer opportunities for more ecologically valid and accessible evaluation, although usability, digital exclusion, and implementation issues remain. Neurorehabilitation is increasingly viewed as a treatment that should begin early in the disease course rather than being reserved for advanced disability. Exercise interventions, cognitive rehabilitation, psychological therapies, vocational rehabilitation, and integrated multidisciplinary approaches demonstrate benefits across physical, cognitive, emotional, fatigue, and QoL outcomes. Telerehabilitation and technology-supported interventions, including virtual reality, exergaming, and neuromodulation, show promise in improving access and outcomes, but more research is needed. To sustain long-term neurorehabilitation benefits, teaching self-management strategies and brain-health behaviours may be beneficial.

Neurorehabilitation is a core component of comprehensive MS care, complementing pharmacological treatment. Evidence favours early, personalized, function-focused interventions delivered through flexible, tiered, and multidisciplinary models. Research gaps include implementation of screening pathways, optimization of person-to-treatment matching and dosing, integration of SDoH, development of meaningful patient-centred outcomes, evaluation of cost-effectiveness, and improved equity of access to rehabilitation services and research across diverse populations.