A woman is looking over her shoulder at the portable neuromodulation simulator (PoNS) around her neck. She has a sensor in her mouth.

Have Gait Problems? New MS Device “Talks the Walk”

Walking isn’t always a problem for me (though talking might be!). But when I do get tired, my legs feel very much like they’re made of cement, making it hard to walk very far at all, and certainly not with any ease. I also find myself veering to the left even though I’m facing forward and trying to walk straight. I consciously direct myself to walk a straight line during these moments.

Those living with gait issues have similar experiences. Fortunately, medical ingenuity seeks to solve problems like this one. A new device recently approved by the FDA may help correct one’s gait utilizing an apparatus that actually uses the tongue to keep you on your path.

About gait deficit

Gait deficit is a common mobility issue among people with MS. It describes all the different ways we struggle to walk a straight line.1

  • Muscle tightness or spasticity may interfere with stride.
  • Balance problems can lead to swaying gait (also called ataxia), giving the appearance of drunkenness.
  • Perpetually numb feet make it hard to walk because the body and brain cannot sense the walking surface.
  • “Cement legs” may express a symptom of extreme fatigue caused by MS.
  • Muscle weakness, even in people with well-defined muscles, can change the rhythm of the walking stride. The body will use different muscle groups to compensate for this weakness. In doing so, this creates postural changes that can lead to pain, which can also influence one’s stride.

Not only can gait issues lead to walking problems and pain, but they can contribute to falling risk. Between 50 and 70 percent of people with MS report falling, with 30 percent of these falling multiple times.1

The injuries related to gait problems—broken bones, strained muscles, and fear of falling again could result in less effort to move, fewer exercise periods, and lack of confidence in one’s physical independence.

What is the Portable Neuromodulation Stimulator?

In late March 2021, the FDA approved a stimulator that can, at least in the short term, modify your gait through a device you wear as a mouthpiece.2

The Portable Neuromodulation Stimulator (PoNS) rests in the mouth, delivering tiny electrical impulses to specific nerves within the tongue. These zaps provide a kind of neurological modification that can improve gait. The device comes in two pieces. The small, portable mouthpiece and can be inserted and removed freely, so there’s no need for an implant. The mouthpiece has a thin cord that attaches to a controller worn around the neck, similar to behind-the-neck headphones.2

How does PoNS work?

The controller sends signals to the mouthpiece as it rests on the tongue (imagine holding a slim whistle in your mouth). These signals stimulate the trigeminal and facial nerves, which restore motor function throughout the body, including and especially in the legs.2

Two recent studies show this therapy to be safe and effective in people with MS. Both showed no serious side effects reported over a 14-week period.2

Precautions for using the new PoNS resemble those followed for anyone using that old-school therapy, TENS (transcutaneous electrical nerve stimulation). One must qualify to use the device, as it’s not approved for use by people with:2

  • Penetrating brain injuries
  • Neurodegenerative diseases
  • Oral health problems
  • Chronic infectious disease
  • Unmanaged hypertension
  • Unmanaged diabetes
  • Pacemakers
  • Seizure history
  • Sensitivity to nickel, gold, or copper

Young people under the age of 22 and pregnant women should also avoid using the device.

Traditional ways to manage your gait issues

Of course, this isn’t the only thing you can use to treat your gait issues.

  • More common options include canes, crutches, walkers, motorized scooters, and wheelchairs.
  • Some people own a tall assistance dog which they can rely on for temporary support and balance.
  • Physical therapy can help improve one’s strength and agility, leading to a pain-free gait.
  • Medications for spasticity, fatigue, and to improve walking speed may help.
  • Even the kind of shoes you wear can help or hinder your walking, so keep this in mind the next time you shop for a new pair.

Keep in mind, however, that some training for the use of any device to improve gait is critical for safety and effectiveness. Always work with your MS specialist when exploring walking assistance options.

Would I use the PoNS?

Well, I use its cousin, the TENS, quite frequently for my MS hugs. I personally find neurostimulation a great non-drug approach.

The PoNS appeals to me because it’s hands-free, easily worn around the neck. If I began to experience more frequent or severe gait problems, I’d give this solution a shot. It appeals to me especially as a solution for traveling in and out of airports, when fatigue greatly hampers my ability to walk with ease.

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