Walking (Gait) Impairments
Symptoms of multiple sclerosis (MS) such as muscle weakness, muscle spasticity, impaired motor control, pain and fatigue can make walking very difficult. In this section, we will review a few of the most common gait impairments seen in people with MS as well as several interventions available to help improve walking and reduce the risk for falls. If you have trouble walking, ask your physician for a referral to physical therapy (PT) for an individualized assessment. Being evaluated by a PT with extensive experience treating people with MS, such as those at Shepherd Center's Multiple Sclerosis Institute, is a great place to start.
Your physical therapist will begin with a comprehensive examination and assessment of mobility and gait and may recommend one or more of the following:
Custom Home Exercise Program (HEP)
The manner in which your walking may be affected by MS is highly variable. A custom home exercise program (HEP) specifically designed for you is a key component to improving walking. Common components of HEPs include:
- Stretching: this is a must-have in any HEP. Stretching muscles that are tight can have a great impact on walking. If you do not stretch daily, the tight or spastic muscles will always “win” against the weak muscles and can prevent strengthening and limit progress towards safe and efficient walking.
- Strengthening: strengthening exercises build muscle capacity and also help improve your connection with areas of your body that are harder to move. This will improve gait and functional mobility.
- Gait (Walking) Practice: practicing walking using individualized cues provided by your PT will emphasize areas of trouble and help you to move more easily and efficiently.
- Balance Training: impairments in balance or coordination can be a big part of walking difficulties. These exercises work to improve control and coordination muscles used in walking, standing and functional activities.
- Functional Activities: performing common daily activities in a purposeful way brings stretching, strengthening, gait and balance practice together.
- Establishing an HEP Routine: choose a certain time of day to be “HEP time” and stick to it. It gets very easy to put off exercise until later, and then skip it altogether. What a person does on a daily basis is much more impactful than attending therapy for 45 minutes a week.
Assistive Devices
For people with MS, using the most appropriate stability aid can immediately improve their walking, reduce fatigue, reduce pain, and in some cases open the door to being able to walk at all. Here are a few key points about assistive devices and stability aides:
- Kinds of assistive devices: different walking aids include canes, trekking poles, forearm crutches, front-wheeled walkers, rollator walkers (four-wheeled walker with a seat to rest when tired) or upright rollator walkers with forearm support.
- Different tools for different jobs: having options for different assistive devices according to how you feel each day or what your plans may entail can open up your world and allow you to be more active at home and in the community. For example, many people may use a cane or forearm crutch in the house, but a rollator walker over outdoor surfaces so they can sit when tired.
- Barriers to using assistive devices: a huge barrier to people using the most stable device for walking is fear of what other people will think. We strongly encourage patients to at least try the recommended stability aid a few times. When people experience increased confidence, the ability to go places that were not possible before, the joy of family/friends seeing them walk with less fatigue, pain, and decreased anxiety related to falling (“I’m not going to make it”), they find the benefits outweigh the downsides.
Bracing for Foot Drop
- Foot drop occurs when the muscles that lift the foot at the ankle become weak and the toes or foot begin to drag.
- Foot drop cannot be ignored. If not addressed it will only get worse and lead to many more issues such as being off balance, hip/low back pain and significantly increased risk for falls and serious injury.
- There are many off-the-shelf and custom options for braces that can help with foot drop and range from minimal carbon fiber braces to custom molded solid polypropylene braces that provide more ankle and knee stability if needed.
- At times, the instability at the ankle can lead to hyperextension at the knee that an ankle brace may not address. Your physical therapist may trial devices such as a Swedish knee cage to prevent knee hyperextension.
- The cost of prefabricated and custom braces is typically covered by private health insurance as well as Medicaid and Medicare, making them accessible to nearly all people with MS who need them.
- A common misconception is that wearing a brace will make a person weaker. This is not true. Many times, wearing a brace can lead to a person becoming stronger as they are able to walk farther with less effort.
- If you have questions about whether a brace is right for you, ask your medical provider for a referral to physical therapy for an evaluation.
Neuro-Prosthetic Devices for Foot Drop
- Neuro-prosthetic devices, such as the Bioness and Walk Aide, provide functional electrical stimulation (FES) to muscles which prevent foot drop.
- One limiting factor with FES devices for foot drop is their cost. Unfortunately, FES devices to prevent foot drop are not FDA-approved for persons with MS, and therefore are not covered by most insurance companies. The cost can be prohibitively expensive.
- Not all people with MS are candidates for these devices. If you have questions about whether a neuro-prosthetic device is right for you, ask your medical provider for a referral to physical therapy for an evaluation.
Power Mobility
- People with MS have options for safe mobility. There are safe ways to get around and be engaged at home and in the community for everyone, regardless of your current level of fatigue or function.
- Scooters and wheelchairs are used when walking is too difficult and/or no longer safe. These allow people to be mobile on their own and have independence at home and in the community.
- Shepherd Center's Seating Clinic can help people decide what is the best mode of power mobility for them based on need, options for transportation, home environment, insurance coverage, etc.
- In general, a person can obtain a new means of power mobility every five years or if the person has had a significant change in condition such as physical ability or weight.
Visit the National Multiple Sclerosis Society (NMSS) to learn more about walking (gait) difficulties.
