Mobility and Walking Issues

Multiple sclerosis (MS) can significantly affect mobility, causing challenges with walking, balance, fatigue, weakness, and heat sensitivity that may increase the risk of falls and reduce independence in daily activities. Regular exercise, appropriate mobility aids, environmental modifications, energy-conservation strategies, and support from healthcare professionals such as physical and occupational therapists can help improve safety, mobility, and overall quality of life for people living with MS.

Multiple sclerosis can affect one’s ability to move freely and easily, increasing the risk of walking issues. Fluctuations in mobility can often occur with MS, and these limitations can lead to falls and other safety issues. Mobility is impacted by several factors, including heat sensitivity, fatigue, weakness, and balance problems.

Exercise and physical activity can help to reduce problems with mobility. Mobility aids can improve walking and balance, and environmental modifications can also increase safety and independence. Consulting a physical therapist who is experienced with multiple sclerosis can greatly assist with improving both mobility and safety, which ultimately improves one’s quality of life.

MS Mobility Overview

Mobility is the ability to move or be moved freely and easily, as well as safely. Because of multiple sclerosis, a person’s mobility can vary daily – and even hourly. Medical professionals who treat individuals with MS will often hear such comments as:

“My foot drags, making it challenging to walk to my child’s ballgame.”
“When it’s hot outside, I melt in the heat. My body becomes very weak and moving my legs is difficult.”
“My partner exerts a great deal of energy to walk and move around, causing extreme fatigue. By the end of the week, socializing and other activities are just not possible.”
“I worry about my balance issues and possibly having a fall, especially when no one else is home.”

Safe, independent movement with multiple sclerosis may be challenging for many individuals. This can result in a marked decrease in overall activity – which leads to preventable disuse weakness and deconditioning. If inactivity continues, other problems can develop. Mobility challenges common in MS can be:

Transitional movements, such as when one moves to and from sitting and standing positions, from chair to chair, or when rolling over in bed and other mobility problems when lying down
Walking issues, which include such challenges as foot drop, knee instability (buckling or hyperextension), spasticity, and weakness
Balance and fall risk; these issues impact the ability to safely sit, stand, and walk
Fatigue, which greatly affects mobility and can at times be overwhelming
Navigating steps, staircases, and other variations in walking surfaces
Wheeled mobility, including transferring in and out of a wheelchair or scooter and access to appropriate spaces designed for wheeled mobility
Activities of daily living encompass a wide range of actions, virtually all of which require some degree of mobility; examples include cooking, cleaning, dressing, bathing, and driving

Optimizing mobility in the face of MS challenges is possible by engaging your healthcare team, specifically your neurologist, nurse practitioner, physiatrist, and a physical therapist (PT) and/or occupational therapist (OT). To follow are the roles that these specialists play:

The neurologist and nurse practitioner consider treatments that can influence movements, such as medications for fatigue, bowel and bladder problems, or for other health conditions.
A physiatrist is a physician who specializes in movement and often provides guidance around spasticity-management strategies.
The PT and OT focus on exercises, mobility aids, as well as environmental adaptations and adaptive equipment

Exercise and Physical Activity for People with Multiple Sclerosis of All Ability Levels

Everyone should have the goal of achieving, and then maintaining, the highest possible level of independent function. This includes safe mobility – both at home and in the community. Having an evaluation from a physical therapist (PT) experienced in multiple sclerosis care is both helpful and recommended.

General Guidelines

Flexibility and Range of Motion
- These exercises should be done daily, two-to-three sets, holding each set for 30-60 seconds
Resistance Training
- Two-to-three sessions per week, one-to-three sets per session, eight to 15 repetitions for each set
- Tip: These exercises can be divided into fewer repetitions or completed intermittently throughout the day
- Tip: Alternate sides as well as upper and lower body exercises to allow more rest time
Cardiovascular Activity
- Two-to-three sessions per week, 10-to-30 minutes each session at a moderate intensity
- Tip: These sessions can be completed intermittently throughout the day
Balance Training
- Function and situation specific, as determined by one’s medical professional (such as a physical therapist), with all activities focused on reducing and preventing the risk of falling

Exercise Resources

Can Do MS offers MS Moves^®, a program designed for individuals with multiple sclerosis to build an exercise routine through exercise videos, Zoom meetings, and other resources.
Yoga Moves MS is a nonprofit organization that seeks to increase the quality of life for individuals with neuromuscular conditions, including multiple sclerosis, by providing live, online adaptive yoga classes at no charge.
MSAA webinars including “How to Exercise to Reduce Fatigue During the Holidays” and “Stretch and Strengthen“

Common Barriers and Possible Solutions

Time – Schedule exercise; intermittently perform exercises throughout the day
Fatigue – Use of cooling devices before and during workout sessions; menu of exercise options for “good days” and “fatigue days”; intermittently perform exercises throughout the day
Motivation – Social system; substitute motivation with routine; menu of options to keep engaged

Mobility Aids for Walking and Balance with MS

Using adaptive equipment or mobility aids are not “giving in” to the disease; instead, it is taking charge and optimizing your mobility by using tools. The most suitable equipment for you will make you feel safer, less fatigued, and optimize your independence, allowing you to live a full and active life.

Tools to optimize walking and balance:

Two-wheeled walker, four-wheeled walker, cane, trekking poles
Braces
- Ankle-foot orthoses; examples include rigid, hinged, and carbon-fiber
- Functional Electrical Stimulation Devices, which help to improve foot drop, gait, and hand function; these include name brands such as Walkaide^® and Bioness^®
- Hip Flexion Assist Device
- Wheeled mobility
- Manual or power wheelchairs, scooters
- Tip: Wheelchairs and scooters can be used selectively as a tool to preserve or conserve energy in certain situations
Other
- The Portable Neuromodulation Stimulator (PoNS^®) is a device that uses innovative FDA-approved technology designed to improve function in people with neurological disorders by treating gait and balance issues; it uses a controller and a mouthpiece to mildly stimulate the tongue’s surface, which in turn improves the flow of nerve impulses to the area of the brain that controls motor function
- Neuromuscular electrical stimulation devices

Environmental Modifications to Improve Mobility

Changes to your environment can improve safety and independence. An occupational therapist (OT) can evaluate your home and work environments to help you determine what tools and modifications will help you optimize your mobility.

In the home, both the bathroom and the kitchen present added safety issues, and certain modifications can be made to address these issues. For instance, in the bathroom, examples of safety items that may be added include grab bars, a raised toilet seat, and a tub-transfer bench. In the kitchen, examples of helpful tools include grip gadgets, modified cutting boards, rocker-bottom knives, and wide-grip utensils.

In the workplace, various needs may be considered. This might include having a dedicated parking space to shorten the walk into the office and to possibly avoid stairs. This would help to increase safety and reduce fatigue. Changes to office equipment can include computer/desk ergonomics to minimize fatigue and standing desks to help with spasticity.

Several vehicle modifications are also available to assist with driving. Examples of modifications include hand controls and extensions, custom driver seats to lift an individual into position, special side and rear-view mirrors to reduce blind spots, and handles to assist with getting in and out of a vehicle.

Other Mobility Considerations for Walking Issues with MS

Achieving and maintaining smooth, safe, and independent ambulation will certainly result in improved health and quality of life. However, when that is not possible, many different options are available for those with limited abilities.

Deconditioning

Deconditioning means reduced physical mobility resulting from limited physical activity and can affect muscle strength and endurance, balance, and cardiovascular fitness. It can contribute to fatigue and diminished confidence with movements often contributing to an increased risk for falls.

Fatigue Management Using the “Four P’s”

Prioritize

 Select which projects and chores are of the greatest importance and which can wait for another day. Attempting too many activities can be exhausting and cause significant fatigue and weakness – increasing the risk for falls and injury.

Plan Ahead 

Once priorities have been set, planning ahead can be extremely helpful for conserving energy and minimizing the risk of fatigue. If doing activities at home, gather supplies in advance and place a chair nearby on which to rest if needed. If running errands or doing other activities away from home, try to plan errands and activities that are nearby one another, to reduce travel time and exertion.

Pace Yourself 

Moving at a comfortable pace, and resting when needed, are key to preserving energy and avoiding fatigue. Rushing through chores or over-exerting while participating in various activities will lead to fatigue and weakness. Once the day’s energy has been depleted, recouping can be very difficult if not impossible.

Position 

Position plays a big role in the amount of energy needed to complete a task. If having to bend over or reach far, this can put extra strain on the body – and extra strain can cause fatigue and shortness of breath. Assistive devices such as reachers and dressing aids can remove much of the burden. Additionally, sitting or standing upright allows for maximum lung expansion and oxygen intake.

Shoes

Shoes should be lightweight, supportive, and have an enclosed heel. A rubber sole can add to stability, however, rubber soles or sneakers may not be appropriate for everyone, particularly in the presence of foot drop, because a rubber sole can cause the foot to occasionally stick.

Reviewed by MSAA Chief Medical Officer Barry Hendin, MD
Contributor: Mandy Rohrig, PT, DPT, MSCS
Original content by Patricia G. Provance, PT, MSCS