Multiple Sclerosis (MS) is an autoimmune disease where the immune system attacks the myelin sheath covering nerve fibers. This damage disrupts communication between the brain and the body, leading to neurological symptoms. Walking difficulties are common, affecting up to 80% of people with MS, but the ability to walk varies significantly. Many individuals maintain mobility by adopting modifications and utilizing treatments to manage symptoms.
How MS Affects Gait and Balance
Lesions caused by MS in the brain and spinal cord impair the neurological pathways responsible for coordinated movement and balance. This disruption compromises the normal walking pattern, or gait. Individuals often experience decreased walking speed, reduced stride length, and increased time spent with both feet on the ground (double-stance interval).
MS-related fatigue is a profound lack of energy not proportional to recent activity. This debilitating fatigue drains the energy needed for walking, requiring the brain to exert more effort for simple motor tasks.
Spasticity, characterized by muscle stiffness and involuntary tightness, particularly in the leg muscles, interferes with smooth walking motion. This constant tension reduces the range of motion in joints, forcing an altered gait pattern. Stiffness also increases the energy cost of walking, worsening fatigue.
Damage to sensory nerves, especially those involved in proprioception, impairs the body’s awareness of limb position without visual input. This sensory loss contributes to ataxia, an unsteady, uncoordinated movement leading to a staggering gait. Weakness in ankle muscles can cause foot drop, where the toes drag or the leg must be lifted high to avoid tripping.
Non-Pharmaceutical Strategies for Mobility
Active rehabilitation is crucial for managing MS mobility issues, focusing on maintaining function and conserving energy. Physical Therapy (PT) strengthens muscle groups and improves balance through gait training. Therapists often use vestibular exercises that intentionally challenge balance to help the body adapt and improve stability.
Occupational Therapy (OT) focuses on modifying daily activities to reduce overall energy expenditure. The OT helps patients prioritize tasks, pace themselves, and adjust body mechanics for efficiency, which is vital for managing chronic fatigue. Simple adaptations, such as sitting while performing household tasks, conserve energy needed for walking later.
Regular, tailored exercise prevents deconditioning, which exacerbates weakness and fatigue. Low-impact activities like aquatic therapy are beneficial because water supports the body and helps regulate core temperature, preventing heat-induced symptom worsening. Light resistance training and stretching maintain muscle strength and flexibility, promoting a more efficient walking pattern.
Assistive Devices and Environmental Adaptations
External aids provide immediate support for walking and reduce the risk of falls. A cane offers stability for mild balance issues or unilateral weakness. For greater weakness or coordination problems, a rollator or walker provides a wider base of support. Using these devices is a practical strategy for saving energy and remaining active longer.
Ankle-Foot Orthoses (AFOs) are external braces worn to manage foot drop by keeping the foot neutral. This mechanical support prevents the toe from dragging during walking, making the gait safer and more energy-efficient. Functional Electrical Stimulation (FES) is an alternative that uses electrical pulses to stimulate nerves controlling the foot-lifting muscles, often resulting in a more natural gait.
Simple modifications to the home environment support safe walking and prevent accidents. Adaptations include removing tripping hazards like loose rugs or clutter to ensure clear pathways. Installing grab bars in the bathroom and along stairs provides support and leverage, helping conserve energy and increase independence.
Medications Targeting Gait Impairment
Pharmaceutical treatments manage specific symptoms that interfere with walking ability. The drug dalfampridine is a medication used to improve walking function in people with MS. This potassium channel blocker strengthens electrical signals traveling along nerve fibers damaged by demyelination in the CNS.
Clinical trials indicate that dalfampridine can increase walking speed by an average of about 25% in individuals who respond to the treatment. This symptomatic therapy is often used alongside other disease-modifying agents. Muscle relaxants, such as baclofen, reduce severe spasticity, which indirectly improves gait by lessening muscle tightness and stiffness.