4/2/2014 MS and Walking Francois Bethoux MD Director, Rehabilitation Services The Mellen Center for MS Treatment and Research The Cleveland Clinic Cleveland, OH Disclosures • Acorda Therapeutics: consulting, clinical advisory board, speakers’ bureau, research funding • Allergan: speaker’s bureau • Concert Pharmaceuticals: consulting • GW Pharma: consulting • IMPAX Laboratories: consulting • Innovative Neurotronics: consulting, research funding • Medtronic, Inc.: research funding • Merz Pharmaceuticals: clinical advisory board, research funding 1
4/2/2014 Walking • “…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” World Health Organization International Classification of Functioning, Disability and Health (ICF) http://apps.who.int/classifications/icfbrowser/ [Accessed March 21, 2014] Gait and Gait Cycle • Gait: the manner of walking 2
4/2/2014 Mobility • “… moving by changing body position or location or by transferring from one place to another, by carrying, moving or manipulating objects, by walking, running or climbing, and by using various forms of transportation.” World Health Organization International Classification of Functioning, Disability and Health (ICF) http://apps.who.int/classifications/icfbrowser/ [Accessed March 21, 2014] Mobility • Bed mobility • Transfers • Walking • Climbing stairs • Wheelchair mobility • Driving 3
4/2/2014 Why is Walking Important in MS? • Walking is frequently affected by MS • Walking is affected early in the disease • Walking is important to persons with MS • Walking limitations have an impact on many aspects of a person’s life Walking is Important • Survey of 200 persons with MS in Germany • Asked to rate bodily functions by order of importance • Lower extremity function ranked #1 – 37% of those who had MS less than 5 years – 27% of those who had MS more than 15 years Heesen C et al. Mult Scler . 2008;14:988–991 4
4/2/2014 Impact of Walking Limitations • Survey of over 1,000 persons with MS in the US • 64% persons reported difficulty walking • Of those: – 94% agreed it disrupted their daily life – 82% agreed it restricted their activities – 78% reported decreased ability to work • 39% stated they rarely or never discussed walking problems with their doctors. La Rocca N. Patient 2011;4:189-201. http://www.nationalmssociety.org/About-the-Society/News/Survey-Finds-Majority-of- People-with-Multiple-Scle [accessed March 30th, 2014] Impact of Walking Limitations • Among men and women with MS who report difficulty walking: – 68% ‐ 72% report that it makes walking around dangerous – 60% report that they have fallen (34% with injury) – 60% missed a major personal event – 32% report that it makes them feel isolated La Rocca N. Patient 2011;4:189-201. http://www.nationalmssociety.org/About-the-Society/News/Survey-Finds-Majority-of- People-with-Multiple-Scle [accessed March 30th, 2014] 5
4/2/2014 D E ACTIVITY C LIMITATIONS R E A S E D PARTICIPATION RESTRICTIONS M O B I DECREASED L QUALITY I OF LIFE T Y Bethoux F and Bennett J. Enhancing mobility in multiple sclerosis. IJMSC 2011;13(1):1-3 How is Walking Affected by MS? • Fatigue • Weakness • Spasticity • Loss of coordination • Loss of sensation • Visual loss • Bladder issues • Depression 6
4/2/2014 MS Disease D Process Practitioner E Knowledge ACTIVITY C Individual LIMITATIONS Factors R E A Neurologic Access to S MS Care Impairments And Symptoms E D PARTICIPATION Environment RESTRICTIONS M O Co-morbidities B I DECREASED L QUALITY I OF LIFE T Modulating Adherence Y to Factors Treatments Bethoux F and Bennett J. Enhancing mobility in multiple sclerosis. IJMSC 2011;13(1):1-3 How is Walking Assessed? • With our eyes • With a stopwatch • With a tape measure • With a gait analysis device • With a pedometer / oscillometer • Wih a GPS device • By asking you… 7
4/2/2014 Examples of Gait Analysis • Before physical therapy • After 5 weeks of physical therapy Key Aspects of Walking Comfort Efficiency Safety 8
4/2/2014 How Can I Improve My Mobility? MS Disease- Disease D Modifying Process Practitioner Therapies E Knowledge ACTIVITY C Individual LIMITATIONS Factors R Symptomatic Medications E A Access to Neurologic Impairments S MS Care And Symptoms E Wellness D PARTICIPATION Environment RESTRICTIONS MS CareTeam (e.g. Nursing, Psychology) M Other Specialty O Care Co-morbidities B Primary Care I DECREASED L QUALITY Rehabilitation I OF LIFE (includes assistive T Modulating technology) Adherence Y to Factors Treatment Bethoux F and Bennett J. Enhancing mobility in multiple sclerosis. IJMSC 2011;13(1):1-3 9
4/2/2014 The Basics • Stay active • Stay fit • Stay healthy • Talk to your health care provider Stretching / Exercise 10
4/2/2014 Mobility Aids It’s NOT Giving In… Braces 11
4/2/2014 Other Devices • Functional electrical stimulation (FES) for foot drop (http://www.nationalmssociety.org/NationalMSSociety/media/MS NationalFiles/Brochures/Article ‐ Two ‐ New ‐ Devices ‐ for ‐ Foot ‐ Drop.pdf) • Hip flexion assist device Hip Flexion Assist Device 12
4/2/2014 Treatments for Walking Treatments for Treatments for Spasticity Pain Medications Other Symptom Treatments for Treatments the Disease In Summary • Preserving mobility is a priority • You are in the driver’s seat, health care providers are here to help • Keep moving! 13
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