Table of Contents
1. Disease Progression
2. Treatment
3. Gait Disturbance
4. Dizziness and Vertigo
5. Sensory Changes
6. Spasticity
7. Fatigue
8. Balance Problems
9. Mobility Aids
10. Conclusion
11. Real Life Experience
12. References
13. Patient Resources
Multiple Sclerosis is a chronic and debilitating disease that attacks the myelin sheath surrounding the nerves of the human body. Multiple Sclerosis is thought to be an autoimmune disease, whereby the body turns on itself and breaks down the myelin surrounding the nerve fibers. Myelin is a substance made up of multiple types of cells, one of which is cholesterol. Myelin acts as an insulator and propagator of electrical impulses. As damage to the myelin sheath occurs, the contact between the nerves covered by the myelin sheath and the brain and spinal cord become disrupted. This damage results in a lack of communication and subsequently effects the sensory and motor pathways of the human body. The disruption that occurs can result in sensory or motor deficits, diminished strength, lack of coordination, change of gait and ability to speak clearly.(1)
The rate at which the human nerve demyelinates, once one is diagnosed with Multiple Sclerosis, is not predictable. Patients may live decades without any significant limitations of their motion or sensory acuity. Others may loose their myelin sheath quickly and in turn may experience a sudden and rapid decline of their sensory, motor and speech functions. To complicate matters, disease symptoms may vary depending on the time of year, down to the time of day.
There is no known cure for Multiple Sclerosis. Treatment of Multiple Sclerosis occurs by managing the recurrence of symptoms, reducing the flair frequency and managing the severity of the disease flairs.(2) The strategy of treating acute attacks is handled differently than the strategies instituted to slow the progress of Multiple Sclerosis. In addition, the treatment of disease symptoms affecting lifestyle issues are very important. Instituting methods to ease debilitating motor symptoms can be helpful when activities of daily living are being effected.
One of the most significant issues of progressive Multiple Sclerosis is difficulty with walking. As is often the case with the disease process, the patient may be able to walk with only minor difficulty for many years. During this disease progression, the slow decline of motor function required for the process of walking is often insidious.
Dizziness and Vertigo
Dizziness and vertigo affect a patient’s ability to ambulate indirectly. Though not a major motor issue, dizziness tends to cause a spinning sensation that leads to a motor imbalance. To make matters worse, current pharmaceutical therapies to treat the uncomfortable nature of vertigo, such as Benadryl and Antivert, produce side effects that increase the imbalance.
The feet and legs are particularly susceptible to numbness, in the patient with Multiple Sclerosis. This numbness provides the patient with an inability to feel the ground during the process of walking, leading to gait instability and the need for an external means of physical support. Because there is no pharmaceutical protocol that significantly reduces these symptoms, the addition of well-fitting, stabilizing shoes and the use of a cane can be very helpful.
Demyelination of the nerve sheaths is thought to be the culprit behind the increased muscle tone seen in patients with Multiple Sclerosis. The increased muscle tone leads to spasticity, which then lends itself to stiffness and walking difficulty. Spasticity can range from barely noticeable to severe and most often affects the muscles of the lower body, including the buttocks, thigh and calf muscles.
Deconditioning, combined with overexertion, can impact
walking in the patient with multiple Sclerosis. Management of the fatigue and physical conditioning can aid in the reduction of these symptoms. Physical therapy, a regular workout routine and some adjunct physical support, can go a long way in minimizing the impact of fatigue on the patient with Multiple Sclerosis.
There is no medication regimen that can manage balance issues, in the patient with Multiple Sclerosis. Balance problems can be minimized by a good physical therapy program, however the best management of balance issues is the implementation of a mobility aid.
With the diagnosis of Multiple Sclerosis comes the need to adjust the activities of daily living, as well as supply an adjunctive way to manage the physical instability that comes along with the disease. The need for walking assistance can sneak up on the patient. A patient’s normal gait begins to sway or the ability to walk produces increasing or more rapid fatigue. Patients can spend years of decline without recognizing the need for assistance. Most Multiple Sclerosis patients with motor function issues are involved in ongoing physical therapy. Often it will be the physical therapist that recognizes the need for some form of mobility or walking assistance.
The time when a patient may require the use of a mobility assistant device will vary from person to person. The factors that should be taken into consideration when deciding whether or not to add a mobility device to the patient’s daily regimen include:
• Does the act of moving from one location to another provoke stress of worry?
• Are the patient’s feet so numb that they feel clumsy when walking?
• Does the patient remain house bound for fear of being unable to ambulate?
• Does the patient remain house bound for fear of being made fun of?
• Does the patient have a history of more than one fall in the past 30 days?
• Has there been a recent flair up of symptoms?
• Does the patient have a noticeable limp or gait imbalance?
• Does the patient require others to take their arm or help them balance, when walking?
If the answer to any of these questions is YES, it’s most likely time to consider adding a mobility device to the management regimen.
There are several options to assist with the process of walking. A cane is often the first line of action for Multiple Sclerosis patient’s with motor issues.
The biggest fear for some patients with Multiple Sclerosis is the fear of lack of control or the need to rely on others for daily tasks. A cane can offer independence and open up your options and provide peace of mind.
Assistance in fitting for a cane can be very important in the patient with Multiple Sclerosis. A proper fit and the training to use the cane effectively can often be found within the scope of services offered by a licensed physical therapist.
Multiple Sclerosis comes with some issues that can be difficult to deal with, but the diagnosis doesn’t have to dictate how a patient lives their life or manages their daily activities. There are options available that can ease the management of the patient’s day and provide them with the ability to be self-reliant and independent.
"I had walking problems from the onset of my MS in 1980. Due to my poor balance, it didn’t take much to fall down: a cracked sidewalk, a throw rug… Walls, furniture, and buggies sufficed for a while until one day I fell crossing a street. I got hurt and was too scared to be embarrassed. A broken bone would impose serious consequences. From that day forward, I chose safety over vanity. Then I broadened my perspective: Canes help with walking, like eyeglasses help with poor sight. And I could still be fashionable! I bought canes in various colors and styles to match my outfits."
1. Olek MJ. Epidemiology and clinical features of multiple sclerosis in adults. Uptodate.com. Accessed Sept. 19, 2012.
2. Olek MJ. Treatment of relapsing-remitting multiple sclerosis in adults. Uptodate.com. Accessed Sept. 19, 2012.
Patient Resources
Multiple Sclerosis and Gait Abnormalities is Written by: Dr. Elizabeth Lewis