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The Mechanics of MS and Walking

                                            Image result for walking images



I don't know about you, but my walking talents tend to alter daily. At first I thought it was all about shoe choice. I have to wear flats of some sort that fit snugly to my foot and not allow any "flopping". That theory felt right, but when I realized that wearing the same shoe on consecutive days didn't necessarily work , I had to reevaluate my ward robe and  activity decisions. 

One very strange thing I have noticed about walking comfortably is the texture on which I rest my feet. Until a year or so ago, the closest shopping mall had tiled or "hard" floors, making walking not as hazardous as some shopping areas. When the mall owners revamped and changed the main walking space between individual stores  with a rugged indoor/outdoor type carpeting, I could no longer walk without stumbling. I now hate going to the mall more now than I ever did. By the time I travel from one end of the building to the other,I am totally wiped out, in pain, dizzy, and feeling 100% disabled. And it doesn't help when my panic reaches desperate lengths in not knowing where the nearest rest facility is located...like...RIGHT NOW!

Foot drop has probably been my most consistent MS symptom. Even on the rare occasion I do not use a cane and actually feel confident with placing one foot in front of the other, I am on code red alert. It is not unheard of for me to just fall over with no provocation at all. My body tends to do what ever the h-e-double hockey sticks it wants. 

And now...someone else's research...


MS walking problems are unique to each patient 


Walking problems vary considerably from one person with MS to another. Common difficulties are:
  • Unsteadiness on walking or turning
  • Slower, shorter steps
  • Less confidence
  • Needing support from walls, furniture or other people
  • Tripping and stumbling
  • A heavy feeling in the legs when stepping forward
  • Weakness of the leg when weight is on it
  • Difficulty placing the foot on the ground
A symptom called foot drop can be experienced by some people with MS. This is when the front part of the foot does not lift up correctly when the leg does, and so it may drag or catch on the floor.
In MS, many of these problems are initially caused by slowed or altered nerve conduction, which can make your muscles feel weak or suffer spasticity or stiffness. Instructions from the brain to the legs and sensory feedback from the body can be impaired. This makes coordinating the muscle movements harder and require more concentration. Some people with MS have more trouble with walking when they try to do other things at the same time.
Other MS symptoms can have a large impact on walking too. If your vision is blurred or double, or you have altered depth perception, you might find it difficult to place your feet accurately or judge steps and kerbs. Problems with balance, dizziness and tremor can affect walking and so can pain. You may feel less confident, or hold yourself awkwardly when you walk in order to reduce pain elsewhere in the body. These postural habits can produce knock-on problems themselves. Walking like this requires more effort which can contribute to fatigue, and holding the body awkwardly can stress other joints and cause long-term damage.
People with MS who have walking difficulties advise getting help early, so as to prevent this damage making life more difficult in the long run.

What can I do to improve my walking?

​The best way forward depends on what is causing the walking difficulties. A health professional such as a GP, MS nurse or physiotherapist can advise, but here are some tips and techniques that may help. See also the links and references below.
  • Orthotics or splints can support weaker parts of your legs
  • Some drugs may reduce fatigue, spasticity and pain
  • Physiotherapy may help to improve your posture and gait
  • Walking aids like canes or walkers can give confidence when out and about
  • Use mental visualisation techniques to practice walking in your head and train your brain 
  • Computer games or virtual reality may help train the brain and improve balance
  • Music and rhythmic cues can help with walking speed and gait regularity
  • Gentle exercise such as yoga can improve core strength, leg strength and reduce fatigue
  • Try to remove trip hazards like trailing wires and rucked up carpets in your environment

This happened to me: Walking Aids

​Steve writes: Like most MSers, I really don't need anything else to make me feel unsteady on my feet. For this reason, I'm not a massive fan of snow and ice!  I highly recommend Yaktrax for snowy conditions. They are basically snow chains for your feet, and strap on over your footwear.
Like a walking stick, they're something simple that can make you feel independent in all weathers if you have any mobility or steadiness concerns.

References
  • Seebacher B et al.The effect of rhythmic cued motor imagery on walking, fatigue and quality of life in people with multiple sclerosisMultiple Sclerosis Journal 2017 23(2) 286-296Summary(link is external)
  • Pearson, MExercise as a therapy for improving walking ability in adults with multiple sclerosis: A metanalysisArch. Phys.Med Rehabilitation 2015 96 (7) 1339-1348Summary(link is external)
  • Kalron A et al.The effect of balance training on postural control in people with multiple sclerosis using the CAREN virtual reality system: a pilot randomized controlled trial.Journal of Neuroengineering and Rehabilitation 2016 13 (3) 13Full article(link is external)


Some more cold, hard facts...

The International Classification of Functioning, Disability, and Health defines walking as “moving along a surface on foot, step by step, so that one foot is always on the ground, such as when strolling, sauntering, walking forwards, backwards, or sideways.” Walking limitations are a key component of disability in patients with MS. Approximately 75% of patients with MS experience clinically significant walking disturbance,, which may be present even in early stages of the disease and in patients with mild disability. A study by Martin and associates reported significant abnormalities in temporospatial parameters of gait, such as walking speed and stride length, in patients with recent-onset MS compared with matched controls without the disorder, even in the absence of pyramidal dysfunction. Similarly, Johansson and colleagues reported that whereas 89% of patients with moderate Expanded Disability Status Scale (EDSS) scores (4.0–5.5) had walking disability, 22% of those with mild scores (1.0–3.5) also had clinically significant gait deviations.
The importance of walking is increasingly being recognized from the MS patient's perspective., In a study conducted in 1980, gait and motor disturbances were the primary complaints in 85% of patients with MS. In a more recent study in which patients prioritized the importance of 13 bodily functions, lower-limb function was ranked the highest regardless of actual level of disability and disease duration.Similarly, among factors affecting quality of life, mobility was given the highest priority by 65% of patients with MS. Gait deviations were also shown to be a significant predictor of patient independence, with slower speed, shorter stride length, and decreased distance walked identified as contributing factors to patients' perceptions of their ability to perform activities of daily living.
In 1994, the lifetime cost of the disease for a patient with MS was estimated to be approximately $2.2 million. Nonmedical costs have been identified as a major component of the economic burden of MS. In particular, productivity losses have been reported to be the single highest contributor to the societal burden associated with MS. The contribution of walking limitations to lost productivity was demonstrated by Edgley and coworkers in a Canadian study of determinants of unemployment among patients with MS. In this study, participants who were unemployed had significantly more walking limitations than did those who were employed, with these limitations being most frequently cited as the reason for unemployment. These observations were consistent with those of an earlier study that used a statistical technique termed “path analysis” to construct a causal model to explain employment status in patients with MS. The model showed that loss of mobility was the major determinant predicting unemployment.
The increased recognition of the importance of walking limitations in the lives of patients with MS leads to a need for regular assessment of walking in order to monitor clinical disease activity and assess the efficacy of symptomatic and rehabilitation therapies. The corollary is that the instruments used for such assessments must satisfy a number of requirements.



And, now, words from my favorite go-to read on multiples sclerosis...

WHAT CAUSES WALKING PROBLEMS WITH MULTIPLE SCLEROSIS?

Two-thirds of people diagnosed with multiple sclerosis (MS) eventually need some kind of mobility device — such as a cane, walker, or scooter — to help them be as active as they want to be. In other words, walking may be impaired, but mobility doesn’t have to be.
When you have MS, many different factors can affect your ability to walk easily and safely, so the first step is to identify the sources of the problem. Following is an overview of some things that can trip you up.



Back to me, the blog owner...

    For the past few weeks I have been under the supervision of a physical therapist who has gone above an beyond in her quest to assist my walking issues. As a professional adhering to her responsibilities Rebecca is firm, but as a human being she is compassionate to my physical limitations.
   The homework exercises I practice weekly have been most helpful in both physicality as well as mental awareness to what I am actually doing as I put one foot in front of the other. And that all lends to emotional strength.
   I still do not like to venture too far from my comfort zone where walking is concerned, but at least I am better armed in facing that demon. The lesson here: Anything is possible. Never give up.

   Hopefully soon I will hear from the orthosis people about my new "leg". Not really a "leg" but that gets folks when I say it. I was fitted for a costumed brace a couple of weeks ago and am anxiously awaiting news. The brace will support my hyper-extended knee while lifting the toes on my right foot in order to stop the "flopping." Very exciting!

The more I read about walking and multiple sclerosis, the more (duh) I find that offers hope. All this time I believed that the muscles in my right leg were terminally affected by MS, but the following article gives me hope. A hope that is nurtured by all the exercises Rebecca continues to enforce upon me. So, I will continue to chastise my legs with weighted knee raises and numerous squats. And you can also!

Have a great week.
Tip toeing through the tulips,
Lisa


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