Gait refers to how a person walks, encompassing the pattern and style of their movement. For individuals with Multiple Sclerosis (MS), gait problems are a common symptom, affecting many living with the condition. These difficulties can profoundly impact daily life and independence, making simple activities more challenging and increasing the risk of falls. Addressing gait issues is a central aspect of managing MS to help maintain mobility and quality of life.
Understanding MS Gait: Common Characteristics
Gait problems in MS manifest in various ways, often making walking unsteady or less efficient.
Foot Drop
Foot drop is a common symptom where a person struggles to lift the front part of their foot, causing it to drag or catch on the ground. This can lead to a high-stepping walk or frequent tripping and stumbling.
Spasticity
Muscle stiffness and involuntary spasms, known as spasticity, affect gait. Spasticity, particularly in the legs, can make movements jerky, stiff, or cause the leg to drag in a semicircular motion. This increased muscle tone can make it feel as though the foot is “glued to the floor.”
Ataxia
A lack of muscle coordination, termed ataxia, results in an unsteady, wide-based, or staggering walk. Ataxia can cause clumsiness, impaired eye and limb movements, and a swaying gait, sometimes described as a “drunk walk.” About 80% of people with MS experience some degree of ataxia.
Muscle Weakness
General muscle weakness, especially in the legs, can compromise balance and the ability to bear weight. This weakness can result in a changed walking stride, making it difficult to raise the leg and causing the toes to drag. Individuals may compensate by “vaulting,” shifting weight to the stronger leg to swing the weaker one through.
Sensory Issues
Sensory issues, such as numbness or tingling in the feet, can impair proprioception—the body’s sense of its position in space. This lack of sensory feedback makes it difficult to know where the feet are placed, leading to an unsteady gait or a “stomping walk.” Symptoms may worsen in dimly lit rooms or at night when visual cues are reduced.
Fatigue
Fatigue is a prevalent symptom of MS that can worsen gait problems. It can limit stamina and cause walking difficulties even over short distances or as the day progresses. This can lead to a need for more concentration to maintain walking, contributing to exhaustion.
Balance Problems
Balance problems are a frequent consequence of MS, directly contributing to instability and an increased risk of falls. Research indicates that 50%-70% of people with MS report falls within a six-month period, with many experiencing multiple falls. Fear of falling can also lead to avoidance of activities and social isolation, further impacting quality of life.
Neurological Basis of Gait Impairment in MS
Gait problems in Multiple Sclerosis arise from damage within the central nervous system, involving demyelination and axonal damage. MS is an autoimmune disease where the body’s immune system mistakenly attacks myelin, the protective sheath covering nerve fibers in the brain and spinal cord. This attack leads to areas of damage called lesions or plaques.
When myelin is damaged, the ability of nerves to transmit signals is disrupted, causing them to slow down or even stop. This interruption in nerve communication makes it difficult for the brain to coordinate walking movements effectively.
Spinal Cord
Lesions in the spinal cord can disrupt nerve signals to the legs. This disruption leads to muscle weakness, spasticity, and sensory deficits like numbness, affecting a person’s ability to walk.
Cerebellum
The cerebellum, a part of the brain important for coordination and balance, is often affected by MS. Lesions in the cerebellum can result in ataxia, causing unsteadiness, impaired limb movements, and difficulties with maintaining posture. Cerebellar damage can also lead to shaky eye or hand movements.
Brainstem
Lesions in the brainstem, which connects the brain to the spinal cord, affect pathways involved in balance and motor control. These lesions can interrupt nerve pathways, contributing to symptoms like dizziness, coordination problems, and impaired strength.
Damage to the motor and sensory pathways impairs the brain’s ability to control movement and perceive body position. The disrupted transmission of nerve signals makes the complex process of walking challenging.
Strategies for Managing MS Gait
Physical therapy (PT) plays a role in managing gait issues in MS by focusing on restorative and compensatory approaches. Physical therapists design programs that include gait training, balance exercises, and strengthening routines for the legs and core. Stretching exercises are also incorporated to reduce muscle stiffness and improve flexibility.
Occupational therapy (OT) helps individuals adapt daily living activities and their home environment to improve safety and mobility. Occupational therapists teach energy conservation techniques, such as breaking tasks into smaller steps, to manage fatigue and prevent strain during daily routines. Home modifications like installing grab rails, rearranging furniture for easier navigation, or adding ramps can enhance safety and comfort.
Assistive Devices
Various assistive devices can aid stability and movement for those with MS gait problems:
Canes and crutches widen the base of support, reducing the risk of falls.
Walkers and rollators provide greater support, often including seats for resting.
Ankle-foot orthoses (AFOs) are braces used to support the ankle and foot, preventing foot drop.
Functional electrical stimulation (FES) devices help with foot drop by activating weakened muscles.
Medications
Medications can alleviate specific symptoms that contribute to gait problems. Baclofen and tizanidine are used to treat spasticity, reducing muscle spasms, cramping, and tightness. Dalfampridine is another medication approved to improve walking speed in people with MS.
Lifestyle Adjustments
Lifestyle adjustments are also important for managing MS gait. Effectively managing fatigue, a common symptom that worsens gait, can improve walking ability. Regular exercise helps maintain strength, balance, and overall physical function.
A multidisciplinary approach, involving a team of healthcare professionals, offers comprehensive care for MS gait management. Neurologists, physical therapists, occupational therapists, and other specialists work together to address the varied symptoms and challenges. This team-based strategy helps to create individualized treatment plans.