One of the most visible consequences of multiple sclerosis is an impaired ability to walk. At some point during the course of the disease, the majority of people with MS (up to 87 percent) experience walking limitations. That shocking figure comes from a 2008 survey of more than 2,000 people living with MS commissioned by Acorda Therapeutics and the Multiple Sclerosis Association of America.
Walking difficulties can be affected by muscle weakness (in legs and trunk), spasticity, loss of coordination, balance problems, sensory deficits, pain, visual loss, cognitive deficits, and fatigue. The resultant abnormal gait patterns and decreased mobility can lead to comorbidities such as osteoporosis, musculoskeletal pain, osteoarthritis, cardiovascular and respiratory deconditioning, and increased risk of falls.
How is walking performance measured?
An important part of each neurologic exam is the assessment of walking ability. It includes speed, coordination, and balance. There are several walking tests used during a typical exam, such as walking tandem heel-toe, up on tip toes, or back on heels. The timed 25-feet walk (T25FW) is a very popular assessment that measures walking speed. When the body is working well, it doesn’t take long to quickly, but safely, walk 25 feet. That stroll shouldn’t take more than about three to five seconds for an average, healthy person. It may take more than ten seconds for a person with MS.
Ways to protect and improve walking performance:** 1. Disease-modifying therapies (DMTs)** may help to preserve walking ability by reducing the frequency and severity of MS relapses and/or by slowing down disease progression. Less disease activity is a goal of DMT treatment, which should help to protect a variety of functions, including ambulation (walking).
2. ** Rehabilitation programs** that combine stretching, strengthening, aerobic exercise, and gait training may help improve walking speed by increasing the body’s capacity to function efficiently and with confidence. It is very important that persons with MS have the opportunity to work with a rehabilitation specialist with experience in multiple sclerosis or neurological rehabilitation. Sometimes something as simple as routinely stretching the Achilles tendon can make a huge difference in walking ease and ability.
For persons with greater limitations, specialized approaches such as body weight-supported treadmill training, balance board exercises, and the Ekso® wearable robotic device may help improve walking ability.
3. Passive assistive devices and walking aides such as canes, crutches, and walkers are often used when walking has become too unsafe or inefficient. A neurophysiologist would be well positioned to evaluate your needs and make recommendations on what type of equipment you might need and instruct you on how to use it properly.
If needed, the physiologist or physical therapist could also fit you for orthoses or braces to correct abnormal limb posture. An ankle foot orthoses (AFO) is used to stabilize the foot and ankle during standing and walking, frequently correcting foot drop, but may also indirectly impact how the knee functions.
4. Active assistive devices such as a functional electrical stimulation (FES) device can be used to compensate for foot drop. This device delivers an electrical stimulation to the peroneal nerve to facilitate active ankle dorsiflexion (foot flexed upward and toward the shin). Two brands of FES devices commonly used in MS patients are the WalkAide and Bioness L300.
The Bioness L300 Plus device comes with a thigh cuff to provide better control over bending and straightening the knee to help smooth the gait. A different type of device, the Hip Flexion Assist Device (HFAD), uses elastic bands to augment active flexion during the swing phase of gait, and thereby improves walking performance and lower extremity strength.
5. Symptomatic treatment might improve walking ability by alleviating underlying impairments that interfere with efficient ambulation. Spasticity can cause stiffness, increased muscle tone, decreased range of motion, and involuntary movements such as spasms and clonus. Spasticity interferes with voluntary movement through co-contraction of opposing muscle groups around a joint, and may be reduced with oral medication (baclofen or tizanidine), botox injections, intrathecal baclofen therapy, or orthopedic surgery.
6. Specialized medication such as ** Ampyra (dalfampridine)**, otherwise known as “the walking pill,” is used to improve walking speed in patients with MS. Dalfampridine is a potassium channel blocker that helps electrical signals travel along demyelinated axons. In randomized clinical trials, Ampyra (manufactured by Acorda Therapeutics) was shown to improve walking speed by about 25 percent in 38 percent of participants. The improvement was more significant in participants who were deemed to be “responders” to treatment.
In a recent systematic review of the research literature, it was determined that the overall mean increase in walking speed with Ampyra was 0.07 meters/second compared to 0.06 meters/second for traditional gait training.
Among patients who responded well to Ampyra, the mean increase in gait speed was 0.16 meters/second, while the mean increases for individual gait training interventions ranged from 0.01 to 0.39 meters/second. Researchers conclude that there is not enough evidence to determine whether Ampyra or gait training is better for improving walking speed in people with MS, but both approaches provide only short-lived improvements. Head-to-head comparison studies are needed.
See More Helpful Articles:
Walking Downhill Helps to Improve MS Symptoms Spasticity and Multiple Sclerosis: Not Just A Knot in the Muscles
Rehabilitation Strategies for Multiple Sclerosis
Ampyra (aminopyradine): My Experience
Plummer P. Critical Appraisal of Evidence for Improving Gait Speed in People with Multiple Sclerosis: Dalfampridine Versus Gait Training. Int J MS Care. 2016 May-Jun;18(3):105-15. doi: 10.7224/1537-2073.2014-114.
Kalron A, Nitzani D, et al. A personalized, intense physical rehabilitation program improves walking in people with multiple sclerosis presenting with different levels of disability: a retrospective cohort. BMC Neurology. 2015;15:21. DOI: 10.1186/s12883-015-0281-9
Kraft G. Can People with MS Improve Their Walking? Inside MS. Oct-Nov 2005:62-64.