For people with multiple sclerosis — the autoimmune disease that attacks the brain, spinal cord and optic nerves — walking may become difficult. Damaged nerves can interrupt the signals telling the body to put one foot in front of the other. But trying to treat walking problems by simply buying a cane off a shelf is risky.
“I’d say that approximately 50 percent of the time, patients I see have already gotten some kind of device on their own. But the devices are often not the right type or are being used incorrectly, and patients are at a higher risk for falls,” warns physical therapist Jeffrey Hebert, associate professor at the University of Colorado School of Medicine and director of rehabilitation at the Rocky Mountain MS Center at the University of Colorado.
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The MS Effect on Walking
The breakdown of nerve signals in MS affects walking in many ways. For example, the muscles may not get the message to coordinate properly and may weaken without use. The eyes and sensory nerves may lose the ability to detect where the body is in space. Many people also experience MS-related fatigue, which can make walking harder, especially over long distances.
Exactly how walking issues unfold depends on a person’s unique MS progression and the location of damage. “A bad MS attack in the spinal cord may affect both legs. Or problems may start in only one leg, and then there may be vertigo, balance and vision problems. Add a tremor and problems with coordination, and that’s where people run into trouble walking,” explains Dr. Riley Bove, assistant professor at the University of California–San Francisco School of Medicine and a neurologist at the UCSF Multiple Sclerosis Center.
[See: Osteoarthritis and Mobility: Walking It Out.]
Not everyone experiences walking difficulty. Bove says that historically, about half of all MS patients needed some kind of walking device within 15 years of a diagnosis. “What we’re seeing now is very different. Our research suggests that fewer than 15 percent of patients need a cane after about 15 years. It’s a huge difference,” Bove explains. She attributes the improvements to earlier MS detection, newer medications that may slow disease progression and more proactive treatment that includes physical therapy.
Assistive Walking Devices
For those who struggle with walking, an assistive walking device like a cane or walker can keep them mobile and independent. But there are many kinds of devices. Selecting the best one depends on your needs.
A physical therapist can help make that determination by assessing your physical strengths and weaknesses and uncovering the mechanical reasons for your walking problems.
The most commonly used assistive walking devices include:
Canes
Types. Canes have either a single tip that touches the floor or a broader base that has four tips (a quad cane). They’re available with different grips, which can help relieve pressure on your joints, according to the Mayo Clinic. “Avoid the old-time, small, curved handle. The broader the handle and more ergonomic, the better,” Hebert says.
When they help. Canes offer support with overall balance while standing and walking, especially for people whose legs feel tired when they walk and those who have a foot that trips them as they walk. “The muscle that holds the foot up when trying to swing the leg forward doesn’t pull up the foot. The foot ‘drops,’ and that’s when a trip or fall occurs,” Hebert explains.
Benefits. Canes are light, they help support stability and they can be used to navigate stairs.
Trekking Poles
Types. Trekking poles may have adjustable lengths or fold for convenience. You can use just one pole or a pair. Each has a strap that goes around your wrist and a grip for your hand. Grips come in materials such as cork, foam and rubber
When they help. If your arms are less affected by MS, you can push off of each pole to help propel you forward with each step.
Benefits. Use a trekking pole for support on one side or use two poles — one on each side. “That keeps you centered and keeps the movement of walking as normal as possible. When one uses a cane or just one trekking pole, you tend to lean to that side, leading to an inefficient economy of walking,” Hebert says.
[See: 5 Physical Therapy Procedures You Should Question.]
Walkers
Types. Front-wheeled walkers have four legs, with two wheels in front and rubber tips on the back. Rollators have swivel wheels on all four legs, as well as a seat you can fold down, hand brakes for stopping and a basket.
When they help. Walkers offer more stability on both sides of your body than canes or trekking poles. Rollators can help you go farther, faster, which you may need in a store or a long hallway, for example.
Benefits. Front-wheeled walkers are lighter and cheaper than rollators and are better if you have trouble controlling forward motion and are prone to falls. Rollators offer a seat for resting, which is crucial since muscles fatigue faster in patients with MS. Rollators allow for a smoother walk than canes or trekking poles. “You can truly use it for physical fitness,” Hebert says.
Braces
Types. The most common brace for people with MS is called an ankle foot orthosis, or AFO. It’s typically made of plastic or carbon fiber, with a base that goes in your shoe and a bar that runs up your leg just below the knee. Velcro straps help keep it in place.
When they help. AFOs are best for people who have foot drop or a knee that hyperextends backward.
Benefits. The brace keeps your foot at a 90-degree angle to prevent foot drop and can support the knee to keep it from hyperextending backward when walking.
Moving Forward
The type of assistive walking device you’ll use will depend on your needs and activities. It may be best to have several devices, such as a cane for going up stairs or a rollator for walking longer distances.
Once you and your physical therapist decide which approach is best, the physical therapist will measure and fit the devices to your height. It’s a crucial step. “If it’s not fitted for you, it can cause you to lean on it incorrectly, which may lead to pain in the back and leg,” Hebert warns.
Once you have the device, you’ll need physical therapy to learn to use it. You’ll learn which side to use a cane on, for instance; or how to move forward, take a step and make turns with a walker. Also important, no matter which device you use: learning how to walk on all kinds of surfaces, such as uneven sidewalks or grass.
It may take time to get used to using the device. But Hebert says it will be worth it. “Think of it as an enabling device versus a disabling device,” he says. “It will enable you to be safer and to increase your activity and fitness level.”
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How to Choose the Right Assistive Walking Device When You Have MS originally appeared on usnews.com
