March 16, 2004
Being able to move from one place to another is a capability most of us take for granted. But difficulty walking is one of the most common challenges faced by people with multiple sclerosis (MS), a common neurological disorder. But that doesn't mean people with MS have to give up their activities: Assisted devices ranging from foot orthotics to power wheelchairs can help restore independence in people with mobility limitations.
Problems with walking, or gait, can arise from a number of MS symptoms, such as muscle weakness or stiffness, numbness and poor balance. Fatigue, which is overwhelmingly debilitating in many people with MS, and vision loss, can also affect mobility. Because MS symptoms vary so much, the degree of limitation is also different from person to person. And depending upon the type of MS someone has, symptoms can become progressively worse or come and go over time.
"There's no way to predict how someone is going to feel," explains Dorothy Northrop, director of clinical programs for the National Multiple Sclerosis Society. "In the morning, you might be able to do something that you can't do in the evening. It's like a moving target, which makes it very challenging. You have to always be adapting to find a way to function and do the things that you want to do."
Assessing What You Need
That's where assisted devices come in. But some people with MS must first overcome their own psychological barrier to using devices that may seem to stigmatize them as being weak. "Sometimes people feel like they're giving in if they accept the use of a device, even though it's going to enable them to continue to do things," Northrop says. "It's a hard line to cross, so it's something that people have to build themselves up to."
Once someone with MS and their physician decides that an assisted device would be helpful, the physician will probably refer them to a physical therapist or occupational therapist. These specialists will analyze gait and evaluate muscle strength, coordination and other factors that affect mobility before recommending and fitting a device.
"When we look at a patient we look at their entire being," says Mary Ann Baraibar, an occupational therapist who is a member of the MS Specialty Team at Fairview Homecare and Hospice in Minnesota. "Some of the things that need to be taken into consideration are their type of MS, their physical ability, their cognitive ability, their home environment, and their family dynamic."
Assisted Device Options
While some people might just need a brace, others may require an electric scooter. Among the simplest mobility devices are foot orthotics, such as a brace called an ankle-foot orthotic, or AFO, sometimes worn by people who need a little help with balance. People with poor balance, muscle weakness or stiffness, or those who have numbness in the foot, which can cause the foot to drag—a condition called "foot drop"—might benefit from a cane or crutch. A walker with four legs and wheels provides the next level of stability by allowing the person to hold onto something continually. Certain walkers have seats, which can be particularly helpful to people with fatigue.
Motorized scooters, which are essentially chairs and handlebars perched on a platform on three or four wheels, have become increasing popular, Northrop says. She surmises that's because scooters tend to be less cumbersome and more socially acceptable than wheelchairs. As with other devices, people may bring out their scooter on an as-needed basis. "People with MS might use scooters for particular occasions such as weddings, vacation or holiday shopping," she says.
People who don't have the strength to hold up their upper body or to reposition themselves may require a wheelchair rather than a scooter. While some wheelchairs are manual, others are electric and are usually steered with a joystick. According to Baraibar, it's often important to have a tilt feature on the wheelchair seat so that people can shift their weight and avoid skin breakdown and pressure sores. It's also crucial to fit the chair properly, she says, so the skin doesn't rub.
Even when one has decided what type of device is most appropriate, there are many varieties from which to choose. The devices come in different materials, which vary in weight: The optimal weight of a wheelchair, for example, might depend on one's size and even the type of floor one has at home. Some scooters, along with some canes and crutches and even wheelchairs, can be collapsed so people can store the devices when they're not needed. One way for people to explore their options is to visit www.abledata.com, the Web site of ABLEDATA, a federally funded project that offers information about assisted technology.
Insurance is another consideration many people with MS have to factor
into choosing an assisted device. Getting coverage can be particularly
hard for people whose symptoms come and go, or for people who need assisted
devices because of fatigue, which is hard to measure. Northrop recommends
that the physician or physical therapist provide a detailed explanation
of one's need for the device to the insurance company. And Baraibar says
that there are programs that can help people with MS find financial assistance,
so they can get the devices they need to be able to continue being as active
and independent as possible.
Copyright © 2004, Healthology Inc.