Problems with gait (difficulty in walking) are among the most common mobility limitations in MS. Gait problems are related to several factors.
- Weakness: Muscle weakness is a common cause of gait difficulty. Weakness can cause problems such as toe drag, foot drop, “vaulting” (a compensatory technique that involves raising the heel on the stronger leg to make it easier to swing the weaker leg through), compensatory hip hike, trunk lean, or circumduction (swinging leg out to the side). Weakness in both legs is known as paraparesis; weakness in only one leg is called monoparesis. Weakness can often be compensated for with the use of appropriate exercises and assistive devices, including braces, canes or walkers.
- Spasticity: Muscle tightness or spasticity can also interfere with gait. Stretching exercises and antispasticity medications such as baclofen or tizanidine are generally effective in treating this symptom.
- Loss of Balance: Balance problems typically result in a swaying and “drunken” type of gait known as ataxia. People with severe ataxia generally benefit from the use of an assistive device.
- 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.
Most gait problems can be helped to some extent by physical therapy (including exercises and gait training), the use of appropriate assistive devices and, in some cases, medications for spasticity, fatigue, and walking speed. AmpyraTM (dalfampridine) was approved in 2010 for its ability to improve walking in people with MS. In clinical trials leading to the drug's approval, Ampyra improved walking speed by about 25% in all forms of MS. Careful evaluation by a trained health care professional is essential for creating the appropriate therapy program for each individual. Watch a short video about AmpyraTM..