Choosing the Right Mobility Aids for Multiple Sclerosisby Lisa Emrich Patient Advocate
According to the National MS Society, about 2/3 of people living with multiple sclerosis (MS) have some level of difficulty walking. Problems with walking can interfere with work, travel, social events, and daily activities. Symptoms such as fatigue or spasticity can aggravate difficulties in getting around. Fortunately, many challenges with mobility can be alleviated by using mobility aids. These can be as simple as a cane or foot orthotic or as complex as a power wheelchair or adapted vehicle.
Canes and walking sticks
If your walking has become less sturdy, or you find yourself concentrating harder to move smoothly from one place to another, it may be time to consider using a cane. Canes help you save energy and be safe when moving from place to place. In that way canes are akin to trekking poles for your everyday life. The modern cane has evolved from the simple walking staff to a fashionable accessory made popular in the 17th century to a functional tool used by those with mobility challenges.
Choosing the right cane
A cane reduces the energy needed to walk and decreases your chance of falling — it becomes your new balance. Talk to your doctor and physical therapist to determine what exactly you need in a cane. Do you need help with balance? Or do you need to lean on the cane for support? What type of handle will comfortably fit your hand and not cause new problems? If you get a prescription, insurance might help pay for the cane and physical-therapy training to learn how to use it properly.
Special features that can expand a cane’s usefulness:
- Small wrist strap to help ensure that the cane does not fall beyond reach
- Tripod or four-pronged tip to broaden the base and provide extra stability
- Foldable convenience for storage in small bags or tight spaces
- Built-in or clip-on LED light for walking in dark places or at night
- Built-in grabber to pick up items out of reach
- Built-in seat that provides a resting stop for the walker who tires along the way
Underarm, forearm, and platform crutches
Crutches improve balance and help to support stiff, spastic, or weak legs. There are several ways to walk using crutches so work with a physical therapist to learn how. All crutches should fit properly to reduce risk of numb hands, sore underarms or wrists, and potential nerve damage. Forearm crutches help to eliminate the possibility of pressure sores and nerve damage under the arms. Platform crutches reduce pressure from the wrists and hands, transferring weight through the elbows.
Walkers, with or without wheels
A walker is a good choice for mobility aid if you need help with balance and support on both sides of the body. Walkers when used properly encourage proper body alignment and should be sized for height and weight. Most walkers are lightweight and can be easily folded for transport and storage. A standard aluminum walker may have rubber tips on all four legs, or may have two wheels on the front and rubber tips on the back legs. Accessories may include a cup holder, reacher, pouch, or seat.
Rollators are rolling walkers with two, three, four, or even more wheels. Wheeled walkers come in many different shapes, sizes, and configurations. Wheels come in different sizes and materials; some that turn or swivel for maximum maneuverability and some that allow for use on various terrains. Common rollator features are hand brakes and an adjustable seat with or without a basket underneath. Other accessories may include arm rests, cup holder, meal tray, or storage bag.
Foot drop assist devices
Sometimes balance isn’t the problem. Difficulty with walking may be caused by foot drop, weak leg muscles, or weak ankle muscles. Foot braces, orthotics, and foot lift assists can help correct foot function. These custom-made devices should be professionally adjusted to ensure the best fit to support normal foot function and reduce the chance of tripping. The ankle foot orthotic (AFO) is commonly used in MS, but complaints include the fact that they can be hot, bulky, and awkward.
Functional electrical stimulation (FES) technology
In MS, functional electrical stimulation (FES) technology is used to help contract muscles and improve walking. FES devices can help correct for foot drop and weak thigh muscles. The device is strapped around the leg at specific points — below the knee or around the thigh — to deliver electrical stimulation to the appropriate muscle groups. You must work through a physical therapist to be custom fit for an U.S. Food and Drug Administration-approved device, such as WalkAide, Bioness L300, Bioness L300 Plus.
Combining mobility aids
Although foot devices can be used independently, they are especially effective when used in conjunction with other walking aids. You may find it helpful to use a foot brace while using your walker, or you may find you need the walker only a few days a week. Some days you may not need to use a mobility aid at all. As your MS or energy levels change, your walking aids can be changed, too, based on how you are feeling and your plans for the day.
Wheeled mobility devices
So far each of the mobility devices featured thus far involve moving on your feet. Wheelchairs, scooters, and power chairs are designed to help you get around while staying seated. It is not uncommon to use a wheelchair part time or only when traveling long distances, such as maneuvering through an airport.
Manual wheelchairs can be self-propelled or may be designed only to be pushed for easy transport. Manual wheelchairs come in a variety of sizes to fit different needs. They may be foldable, rigid, lightweight, or heavy. They may even have removable wheels or leg rests to facilitate storage in an automobile trunk. The proper size of wheelchair supports posture and protects joints, while specialized cushions guard against pressure sores.
If you don’t have the strength or desire to push and maneuver a manual wheelchair, you may opt for a scooter. There are many types of scooters with design features to meet specific mobility needs. Scooters can have anywhere from three to six wheels. Speed controls are incorporated into computerized handlebars that are placed directly in front or to the side of the seat. Seats may be raised and swivel, or not. Many scooters can be broken down and easily put into the trunk of a car.
Advanced power chairs are suitable for the person who has reduced movement in their legs or have problems moving an arm or arms. Posture problems make a power chair a good choice. Customized seat cushions and adjustable tilt features relieve pressure, aid in comfort, and allow weight to be redistributed to reduce risk of pressure sores and improve circulation. Some power chairs are height-adjustable to allow for better social interactions. Power chairs are easier to use on a variety of terrains.
Should you get a scooter or power wheelchair?
Scooters are less expensive than power wheelchairs, but they serve different needs. Talk with your occupational or physical therapist and visit a store representative to discuss product options. Keep in mind that quick and convenient access to service technicians for your power device is extremely important. You don’t want to become stranded without a working device. Also, get exactly what you need because Medicare will only cover part of the cost of one mobility device every five years.
Robotic mobility devices in rehabilitation
Robotic devices can be used by neurophysical therapists as part of rehabilitation to assist people with MS to improve physical function. Wearable robotic walking devices include bionic devices, such as the Ekso GT™ exoskeleton gait training system or the Kickstart system. Non-wearable devices include body-weight supported treadmill training systems (BWSTS). FES technology can also be used in conjunction with rehabilitation machines to retrain muscle function.
Mobility devices and adapted vehicles
If weak legs make driving difficult, you can consider adapting your vehicle with hand controls. You will need to pass a driving test to show that you can use them. Walkers and wheelchairs may be folded up and stored in the trunk or backseat of a car. Some scooters may be disassembled and stored in the trunk and others may be attached to the back of a car with a lift. Finally, an accessible van outfitted with a ramp can accommodate power wheelchair users.
Mobility aids support independence
If at first, using a mobility device makes you feel unsure and dependent, don’t fret. It may not be long until you find that mobility aids actually help you maintain independence. With so many options, selecting the ones that are right for your particular needs is not always easy. Enlist the aid of a trusted therapist to guide you through the selection and then teach you how to walk and maneuver with them. That way you will get the maximum benefit.