b'Symptom ManagementMSaannddMMoobbiilliittyyMSTThheerreeaarreemmaannyywwaayysst oaaddddrreesssswwaallkkiinnggiissssuueesstoBy Theodore BrownSince the passage of the Americans withprevention usually starts with a discussion in the Disabilities Actin1990,greatstrides(noMS clinic to understand the contributing factors. pun intended) have been made to improveThis may lead to a physical or occupational therapy accessibility in the workplace, schools, andreferral for work on balance, strengthening, communities. Yet, loss of mobility is still citedtrials of adaptive devices, and home safety as the number one reason for people withevaluation. Recommendations for mobility multiple sclerosis to leave the workforce. aids should focus on enhancing gait stability. Approximately three-quarters of individualsFalls in the home might necessitate home with MS have some degree of ambulatorymodications such as grab bars, equipment impairment, and more than half report havingsuch as tub benches, and fall alert systems. a fall within the previous six months. TheseBraces, which go by the medical term orthoses, high rates are not surprising, given that MSplay an important role in optimizing gait can cause a slew of different problems thatin MS.can impair walkingincluding weakness,The most commonly prescribed brace for spasticity, fatigue, sensory loss, balanceMS is an ankle-foot orthosis, which controls (cerebellar or vestibular) dysfunction, visualankle motion. When appropriately prescribed, loss, and inability to multitask (See page 38AFOs reduce the effect of footdrop, making it for more.) easier to walk longer distances more safely. There is no typical MS walking pattern,For the most part, AFOs are for use outside of but common defects include shortened stridesthe home, and not intended to be worn all the on one or both sides; swinging the leg outtime.MostAFOdesignsaremadeoflight-and around (circumduction) because of footweight thermoplastic or carbon ber materials, drop or spasticity; wide-based, teetering gaitand are either rigid or have a joint at the ankle. because of imbalance; and lack of normalSome require specic types of footwear. Post-op uidity of joint movements because of weaknessshoes,orthopedicshoes,andBillyShoes and spasticity. The good news is that therecan make it easier to get the long blade of the are many ways to help people with MS walkAFO inside of the shoe. Care should be given more quickly, longer distances, with less effort,to getting a good t to avoid blistering and and more safely.discomfort that can lead to discontinuation.Preventing a fall AnAFOmaysufficeforweaknessand Lets start with fall prevention. Each fall hasspasticity that affects the lower leg and ankle. about a one-in-ve chance of requiring medicalHowever, quadriceps and hip exion weakness attention, so anything that can reduce themay need a different bracing solution. A knee likelihood of falling is worth the effort. Fallorthosis can control knee weakness, buckling, msfocusmagazine.org 6'