Authors
Roz Kalb , Psychologist & Meghan Beier , Neuropsychologist
Mobility Aids for MS: If You Need Them, Use Them
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12 Mar 2024 | ~15:16 Engagement Time
Special thanks to our sponsor, EMD Serono.
Difficulty walking in MS is one of the most visible symptoms of MS. So, it’s no surprise one of the first questions a person with a new diagnosis of MS asks is, “Will I end up in a wheelchair with MS?”
In this article, we’ll look at the causes of walking challenges in MS, the symptom management strategies that can address walking difficulties, and the tools available to help a person stay mobile, safe, independent, and active. We’ll also talk about the biggest hurdle to staying mobile, which is the typical attitude that prevents many people from using walking aids.
A person’s ability to walk may be challenged in various ways. Some people may experience only one of the following factors that affect their walking, while other people experience several.
Fatigue is the most common symptom of MS. In addition to the generalized, overwhelming fatigue (called ‘lassitude’) that a person may experience at any time of day, there is also muscle fatigue.
Muscle fatigue in MS may occur after extended muscle use and gradually subsides with rest. It commonly occurs in the limbs – the legs while walking or the arms when lifting or carrying. A physical therapist can recommend an exercise regimen to boost your energy (Yes! exercise reduces fatigue) and strategies to help you manage muscle fatigue when it occurs.
Weakness occurs in the leg muscles when the nerve signals to those muscles are disrupted. When those leg muscles are used less, they gradually become even weaker from disuse. In other words, weakness can contribute to more weakness unless a person learns ways to activate those muscles through exercise and continued activity.
One very common form of MS weakness occurs in the ankle area, causing the toes to drop and drag. In addition, to exercise to strengthen the muscles in the ankle and foot, a physical therapist may recommend a specific mobility aid to hold your toes up and help you avoid tripping.
MS spasticity is a muscle tightness caused by disrupted nerve signals that cause muscles to contract and resist relaxation. Flexor spasticity makes it difficult or impossible to straighten the limb. Extensor spasticity causes the limbs to remain straight and difficult to bend. Spasticity makes walking difficult, tiring, and sometimes painful. Stretching and exercise are the primary strategies for preventing or improving spasticity. Fortunately, there are also very effective medications to reduce spasticity and associated muscle spasms.
Balance problems in MS make it difficult for people to stay on their feet, which can make them appear wobbly or intoxicated. These problems may be caused by changes in vision (also common in MS), sensory changes (numbness, tingling) in the feet and legs, changes in the vestibular (balance) center in the inner ear, and/or any of the other problems listed above.
If you are experiencing any of these changes, your healthcare team – including your MS provider and your physical therapist – can offer management strategies to reduce your symptoms and improve your function.
Even with effective interventions, however, your walking ability may be compromised. You may tire after short distances, feel wobbly on your feet, have an increased risk of falls, or feel insecure – any or all of which might cause you to move less, go fewer places, and engage in fewer activities.
If you notice that your world has gotten smaller, less active or exciting, or less social, it’s time to think about how a mobility aid might offer you some life-changing options.
Often, there is no single mobility aid that will do it all. Consider how many tools you have to prepare meals in your kitchen, do household repairs, or complete your office work. Having a range of tools makes our lives easier, and mobility aids are no different.
A young father with MS opened the trunk of his car to show me his MS tool chest:
As a stay-at-home dad of four teens, he would get up each morning and figure out which tool(s) he needed to carry out his activities for the day. With those mobility aids within easy reach, he could manage the house, go to his kids’ activities, go grocery shopping, and optimize his energy. His motorized scooter made family outings to the zoo, museums, parks, and sporting events a pleasure for everyone. In other words, this man’s collection of mobility aids made it possible for him to do the things that were important to him and to his family.
Choosing mobility aids starts with acknowledging the symptoms that are getting in your way, identifying the activities that have meaning and importance for you, and then working with a physical therapist to identify options and learn how to use each mobility device safely and effectively.
A cane may be all you need to feel safe and comfortable in your home, while a rolling walker or motorized scooter would give you greater security and independence out in the world. An aid that may work just fine in the morning when you have more energy may not provide enough support later in the day when you’re more fatigued.
Most commonly used to support the ankle and foot to prevent foot drop in MS by maintaining the ankle in a fixed position and keeping the toe from dropping or catching on any obstacles like the floor or a carpet.
FES is a small assistive device worn just below the knee that sends mild electrical currents to stimulate the nerves and activates weakened muscles (often resulting in footdrop) . This helps those with difficulty lifting their foot independently to walk more safely and smoothly.
This assistive device uses an elastic strap that runs from an ankle cuff to your shoe to lift the front of your toes as you take a step. Unlike a brace that is fully passive (by always holding your foot at the right angle), the dorsiflexion device allows active motion. This assistive device is effective for someone who drags their foot but doesn’t have complete footdrop.
There are two types of canes: single-point canes and multipoint or quad canes; both can help prevent you from losing your balance. They are lightweight, portable and some are collapsible for more convenient storage when not in use.
Single-point canes are the most common and have a single point touching the floor.
Multipoint or quad canes have multiple floor touchpoints, thus providing additional support.
There are two types of crutches: underarm and forearm. Crutches widen your base of support which reduces your risk of falls and can help relieve some of your body weight from your legs when walking.
Underarm Crutches: worn under the arms are often used on a temporary basis in the case of an injury to relieve weight from a lower extremity completely.
Forearm (or loftstrand) Crutches are more common for long-term use because they support the forearms, provide grips for the hands and are generally more comfortable.
Another common MS mobility aid, walkers and rollators, also widen your base of support, reducing your risk of falls. They are also a great option because they are adjustable, often can be folded, and are portable.
Walkers – A standard walker has a simple frame design and can come with or without wheels. A wheeled walker is simply pushed forward while a wheelless walker is lifted and moved forward as you walk.
Rollator – Usually has wheels on all four legs making it easier to maneuver than standard walkers. They also have helpful additional features like a basket, seat and breaks.
Provide mobility from a fully seated position. They are designed to either be self-propelled or pushed by a caregiver or loved one. In addition, manual wheelchairs can have a folding chair or a rigid chair and can come in a range of weights.
This assistive device is often used in tandem with a manual wheelchair for those who have trouble propelling a wheelchair over variable surfaces like carpets, grass, or gravel. It is a battery-operated motor mounted onto the wheelchair frame that makes it easier to self-propel and conserve energy.
These wheelchairs are battery-driven and come in various design options to accommodate a wide range of needs. They range in their wheel location, wheel size, seating specialization, location, and type of control interface.
Scooters are battery-powered and operate through the use of hand throttles and steering system. They can often be disassembled for storage and transportation and allow you to travel longer distances independently.
For more detailed descriptions, photos, and things to consider when choosing a mobility aid, check out the National MS Society’s brochure How to Choose the Mobility Device that is Right for You
Thoughts like “I don’t want to look disabled…I don’t want to give in to MS…I don’t want people to think less of me…I don’t want to look like an old person…I can do this myself” often prevent people from exploring ways these tools can save energy and improve their quality of life. Our hope is that you will come to see mobility aids as invaluable tools that actually help you look and feel more independent, less disabled, and more in control of your mobility and your life.
Here are a few tips to help you manage any feelings you may be having about needing to do things differently than you did before.
Using the right mobility aid in the right way is the key to success. It’s essential to consult with a physical therapist before purchasing or using a new tool. The therapist will prescribe the appropriate aid, ensure that it’s the correct size for you, and teach you how to use it properly – whether you’re considering a cane, walker, motorized scooter, or wheelchair.
