How to make your plan (step by step)

Start assessment: see a neurologist/PMR for a baseline measurement of strength, gait, balance, fatigue, and cognition.
Personal goals (SMART): e.g., “walk 800 m without stopping,” “climb two flights of stairs,” “reduce falls to 0/month.”
4–8 week cycle: 2–3 visits/week + 20–40 min home program 5–6 times/week.
Review and adjustment: every 4–6 weeks — review goals and workload.
Maintenance: after intensive training — 1–2 times/week or “boost week” once a quarter.

Safety and “red flags”

Exacerbation/suspected relapse → see a neurologist immediately; postpone intensive training.
Overheating (heat sensitivity): train in cool conditions, in short intervals, with hydration.
Falls/new pronounced symptoms → team assessment, change of plan.
Self-prescription of procedures (injections, “miracle IVs,” aggressive manual techniques) — avoid. Focus on evidence.

How to check the quality of a facility

there is a contract with the National Health Service of Ukraine for rehabilitation packages (for free services);
multidisciplinary team with experience working specifically with MS;
individual plan with measurable goals;
regular reassessment and progress report;
patient education and home program;
transparent safety and infection control rules.

Funding

Free of charge with a referral at facilities that have a contract with the National Health Service of Ukraine.
Local programs/NGOs/grants cover certain services or equipment.
Privately — according to the clinic's price list (can be combined with free visits).
If you have a disability, the IPR/MSEC will help you obtain some rehabilitation services free of charge or with compensation.

What to do today (minimum home plan*)
3×/week: aerobic activity for 20–30 minutes (walking/exercise bike at moderate intensity).
2–3×/week: strength training (legs/core/back, 2–3 sets of 8–12 reps).
Daily: balance + stretching 10–15 min.
Fatigue: the “plan-prioritize-pace-rest” rule, short breaks every 30–45 min.
*Consult your doctor/therapist before starting.

Important
The information is provided from the perspective of evidence-based medicine and does not replace a doctor's consultation. Final decisions regarding treatment and rehabilitation are made together with your doctor.

Rehabilitation

Rehabilitation for MS: what is it and why?

Rehabilitation is a systemic care that reduces MS symptoms, maintains independence and quality of life. It is needed not only after an exacerbation, but throughout life with MS: to maintain strength, balance, memory, energy, mood and the ability to work/learn.

When to start: as early as possible. After the diagnosis is made, a basic examination and the start of an individual program. During an exacerbation, the intensity is adjusted by a neurologist.

Where to go in Ukraine?

Family doctor/neurologist

Initial assessment, referral for rehabilitation; coordination of workload during exacerbations.
Institutions with a contract with the National Health Service of Ukraine (free of charge with a referral)

packages “Medical rehabilitation of adults/children in a hospital” and “... in outpatient conditions/day hospital.”

How to find:

check with your facility/on the website/through the registry whether there is a contract with the National Health Service of Ukraine for rehabilitation packages. Ask about the availability of a multidisciplinary team.

City/regional rehabilitation centers

Physical and rehabilitation medicine (PRM), physiotherapy, occupational therapy, speech therapy, psychologist. Often work on an outpatient basis or as a day hospital.

Private rehabilitation clinics and offices useful if the queue at public facilities is long or if you need specialized techniques (e.g., FES, robotic gait, VR therapy). Check the qualifications and experience of the specific rehabilitation specialist.

NGOs/patient initiatives and charitable programs support groups, camps/intensives, vouchers for individual services, online strength/balance programs.

Telerehabilitatio
remote sessions with a physical/occupational/speech therapist, neuropsychologist; home programs with video instructions; weekly support and workload adjustment.

Documents that may be required:

referral from a family doctor/neurologist, medical history,
MRI/test results, list of medications,
if available — IPR/MSEC certificate,
IDP certificate.

Rehabilitation formats

Inpatient (1–3 weeks of intensive care after an exacerbation or with significant limitations).
Outpatient/day hospital (2–5 times a week in cycles of 4–8 weeks).
Home program (daily exercises 20–40 minutes, correction every 4–6 weeks).
Telerehabilitation (video sessions, progress tracking, applications).
Group classes / patient schools (education + motivation + safe exercise).

The team to be involved

FRM doctor/neurologist — clinical supervision and plan.
Physical therapist — strength, endurance, balance, gait, spasticity.
Occupational therapist — daily activities, energy conservation, home/work adaptation, selection of orthoses/assistive devices.
Speech therapist — speech, swallowing, respiratory and vocal techniques.
Neuropsychologist / psychologist — cognition, emotional regulation, anxiety/depression.
Social worker — routes, documents, benefits.
Urologist/gynecologist, proctologist, ophthalmologist - as needed.

What are rehabilitation interventions?

Movement and balance

strength/aerobic programs (RPE control), gait and balance training, FES (functional electrical stimulation), robotic gait/gross treadmills, coordination simulators, hydrotherapy.
Spasticity management: stretching, positioning, orthoses, if necessary, consultation on botulinum therapy (with a doctor).
Activities of Daily Living (ADL) and Energy Conservation
occupational therapy techniques, adaptive devices (ortheses, canes, walkers), "plan-prioritize-pace-rest" training for fatigue, work ergonomics.
Speech and swallowing
speech therapy exercises, neuromuscular stimulation as indicated, safe swallowing, advice on food consistency/position.
Cognitive rehabilitation
training of attention, memory, executive functions; daily "micro-habits" (diaries, time blocks, external reminders).
Monitoring pelvic functions and sexual health
pelvic floor (physical therapist), fluid timing, medication correction with a urologist/gynecologist, bladder training.
Vision and vestibular system
exercises for nystagmus/vertigo, optical adaptations, selection of assistive devices.
Psychological support
CBT/MBSR techniques, working with anxiety/depression, support groups for patients and families.

5 frequently asked questions (FAQ)

1. When to start rehabilitation?
As soon as possible after diagnosis and whenever there is a change in condition. Coordinate the plan with your neurologist/PRM doctor.

2. Where can I get free rehabilitation?
In institutions that have a contract with the National Health Insurance Fund for rehabilitation packages (inpatient/outpatient/day hospital) upon referral.

3. What formats are there?
Inpatient, outpatient/day hospital, home program, telerehabilitation, group classes.

4. Who should be on the team?
Psychiatrist/neurologist, physical therapist, occupational therapist, speech therapist, psychologist/neuropsychologist, and other specialists as needed.

5. Is it safe to exercise when you have fatigue and spasticity?
Yes, but with adaptation: short intervals, intensity control, stretching/positioning techniques, cool down, breaks.

Find rehab in my city

Реабілітація за допомогою роботизованого екзоскелета

How to make your action plan?

Initial assessment: consult a neurologist/physical therapist for baseline measurements of strength, gait, balance, fatigue, and cognition.
Personal goals: e.g., “walk 800 m without stopping,” “climb two flights of stairs,” “reduce falls to 0/month.”
4–8 weeks of the cycle: 2–3 visits/week + home program 20–40 min 5–6 times/week.
Check and adjust: every 4–6 weeks — review goals and workload.
Maintenance: after intensive training — 1–2 times/week or “boost week” once a quarter.

Safety and “red flags”

Exacerbation/suspected relapse → see a neurologist immediately; postpone intensive training.
Overheating (heat sensitivity): train in cool conditions, in short intervals, with hydration.
Falls/new pronounced symptoms → doctor's assessment, change of plan.
Self-prescription of procedures (injections, “miracle IVs,” aggressive manual techniques) — avoid. Focus on evidence!

How to check the quality of a facility

there is a contract with the National Health Service of Ukraine for rehabilitation packages (for free services);
a multidisciplinary team with experience working specifically with MS;
an individual plan with measurable goals;
regular reassessment and progress reports;
patient education and home program;
transparent safety and infection control rules.

Financing

Free of charge with a referral at facilities that have a contract with the National Health Service of Ukraine.
Local programs/grants cover certain services or equipment.
Private — according to the clinic's price list (can be combined with free visits).
If you have a disability, the IPR/MSEC helps you obtain some rehabilitation services free of charge/with compensation

Important!
The information provided is based on evidence-based medicine and does not replace a doctor's consultation. Final decisions regarding treatment and rehabilitation are made together with your doctor.