Several factors may contribute to problems with mobility, including loss of balance, numbness, fatigue, muscle weakness, and spasticity.
Factors that can affect mobility in people with MS
- Loss of balance: Can result in a swaying, unsteady gait (sometimes referred to as ataxia)
- Numbness: Severe numbness in the feet can make it difficult to feel the floor or know location of feet
- Fatigue: Feeling tired and weak from fatigue can affect gait
- Spasticity: Tightness or loss of flexibility in the muscles of the legs can affect gait
- Weakness: Changes in gait to compensate for loss of muscle strength include toe drag, foot drop, vaulting, hip hike, trunk lean
Management of gait and mobility problems
Talk to your doctor if you are having problems with gait or mobility. Careful evaluation of your problem is necessary to determine which therapies or interventions may work for you. The majority of gait or mobility problems can benefit from physical therapy including gait training and strengthening exercises. Use of assistive devices, such as canes, scooters, and walkers, can help people with MS who have severe mobility problems.
A number of medications are available to treat spasticity and fatigue (depending on the cause) and to improve walking speed in persons with MS. The medication AmpyraTM (dalfampridine) was approved by the FDA in 2010 for improving walking speed in people with MS. In patients who respond to the drug, it has been shown to increase walking speed by more than a third.
Management approaches to mobility problems
- Loss of balance
- Assistive devices including canes, walkers, scooters may be useful
- Physical therapy and gait training
- Treatments that may provide relief: niacin, antihistamines, benzodiazepines
- Severe numbness may temporarily respond to a brief course of corticosteroids
- Assistive devices (canes, walkers) may help if there is loss of sensation in feet or loss of contact with floor
- Identify and address the cause of fatigue (sleep disturbance, medication side effect, MS-related lassitude)
- Depending on cause of fatigue interventions include exercise, medication, improved sleep hygiene
- Medications such as baclofen or tizanidine are effective in spasticity
- Stretching exercises and physical therapy with gait training may also be useful
- Exercise and physical therapy with gait training can increase strength and improve gait
- Assistive devices (canes, walkers, scooters) may also be useful