Walking (Gait) Difficulties

Difficulty in walking — also known as problems with gait —  is among the most common mobility limitations in MS.  Walking difficulties are related to several factors:

• Spasticity: Muscle tightness or spasticity can interfere with gait.
• Balance: Balance problems typically result in a swaying and “drunken” type of gait known as ataxia.
• Sensory deficit: Some people with MS have such severe numbness in their feet that they cannot feel the floor or know where their feet are. This is referred to as a sensory ataxia.
• Fatigue: Many people will experience increased gait problems when fatigue increases.
• Weakness: Weakness in your leg muscles can lead to changing your normal walking stride. This change in your walking can then lead to pain, which can make your walking even worse.

Studies from several countries report that 50-70% of people with MS report falls within the past 2-6 months. About 30% of those individuals report falling multiple times, with injuries resulting from those falls. Enhancing a person’s ability to walk comfortably and safely, while preventing falls, is critical.  Not only can falls cause injuries, but the time required to recover from broken bones or strained muscles can worsen mobility problems and reduce independence.People with MS typically fall in or around their homes and neighborhoods, usually while doing basic activities such as bathing, preparing meals or walking in crowded areas.  Risk factors for falls are complex and include:

• Poor balance and slowed walking
• Reduced proprioception (the sensation of where your body parts are in space)
• Incorrect use of assistive devices (canes and walkers) or use of inappropriate devices
• Neurologically active medications (medications that affect the messaging within the nervous system)

Most gait problems can be helped to some extent by physical therapy, stretching exercises, the use of appropriate assistive devices and, in some cases, medications for spasticity, fatigue, and walking speed (e.g., Ampyra).Your physical therapist may suggest exercises or gait training such as vestibular exercises —   designed to induce brief periods of loss of balance. These exercises help you learn to adapt. Exercises may include eye or head movements, distorting or eliminating visual input, and changing or moving weight-bearing surfaces.If you’re having difficulty walking, speak to your healthcare provider.  Fall prevention is important for your mobility, independence and safety. To reduce your risk of falling, try:

• Wearing safe, low-heeled shoes.
• Being conscious of where you are walking. For instance, stay away from a freshly washed floor.
• Making your home safe. Keep the areas where you walk clear. Move electric cords out of the way. Tack down loose carpets or remove them. Apply no-slip strips to tile and wooden floors.