MS and Walking Francois Bethoux MD Director, Rehabilitation Services - - PDF document

4/2/2014 1

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

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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

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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

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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

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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]

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ACTIVITY LIMITATIONS PARTICIPATION RESTRICTIONS D E C R E A S E D M O B I L I T Y DECREASED QUALITY OF LIFE

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

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Practitioner Knowledge Access to MS Care Adherence to Treatments Individual Factors Environment

Modulating Factors

Co-morbidities Neurologic Impairments And Symptoms MS Disease Process

Bethoux F and Bennett J. Enhancing mobility in multiple sclerosis. IJMSC 2011;13(1):1-3

ACTIVITY LIMITATIONS PARTICIPATION RESTRICTIONS D E C R E A S E D M O B I L I T Y DECREASED QUALITY OF LIFE

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…

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• Before physical therapy
• After 5 weeks of physical therapy

Examples of Gait Analysis

Key Aspects of Walking

Comfort

Safety

Efficiency

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How Can I Improve My Mobility?

Disease- Modifying Therapies Symptomatic Medications Wellness MS CareTeam (e.g. Nursing, Psychology) Other Specialty Care Primary Care Rehabilitation (includes assistive technology) Practitioner Knowledge Access to MS Care Adherence to Treatment Individual Factors Environment

Modulating Factors

Co-morbidities Neurologic Impairments And Symptoms

ACTIVITY LIMITATIONS PARTICIPATION RESTRICTIONS

MS Disease Process

D E C R E A S E D M O B I L I T Y DECREASED QUALITY OF LIFE

Bethoux F and Bennett J. Enhancing mobility in multiple sclerosis. IJMSC 2011;13(1):1-3

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The Basics

• Stay active
• Stay fit
• Stay healthy
• Talk to your health care provider

Stretching / Exercise

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Mobility Aids It’s NOT Giving In…

Braces

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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

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Treatments for Spasticity Other Symptom Treatments Treatments for the Disease Treatments for Pain Treatments for Walking

Medications

In Summary

• Preserving mobility is a priority
• You are in the driver’s seat, health

care providers are here to help

• Keep moving!