Loss of mobility in Multiple Sclerosis
In patients with Multiple Sclerosis (MS), loss of mobility is defined as any limitation of movement caused by the sum of different factors which may range from mild to severe, such as lack of motor coordination, muscle weakness, spasticity (muscular rigidity and spasms), balance problems and fatigue, all associated with MS.
People with Multiple Sclerosis may face progressively challenges when performing tasks in their daily lives that are due to the limitations in their ability to move. This can, depending on the severity of the limitations, lead to a loss of autonomy.
Loss of mobility symptoms
Loss of mobility occur as a result of the following issues:
– Muscle weakness: Muscle weakness is a frequent cause that leads to problems walking and performing other activities. Muscle weakness can cause the following problems: dragging of the feet while walking, letting the foot fall, shaking, limping (because the patient supports him or herself on the stronger leg), lifting of the hips… Weakness in both legs is known as “paraparesis” and weakness in a single leg as “monoparesis.” It can be improved by performing the appropriate exercises and using devices that facilitate mobility. These devices include, grab rails, crutches, canes, adjustable beds, wheelchairs, etc. The upper limbs may also have problems associated with muscle weakness.
– Spasticity: Muscular rigidity or spasticity, as well as the muscle spasms associated with these that can also cause mobility problems. A certain degree of spasticity can compensate for a loss of muscle strength, making walking easier, but higher levels make normal walking and activities for which the upper limbs are needed (holding or manipulating objects…) difficult. Pain and other symptoms such as bladder dysfunction and sleep disorders are often associated. Stretching exercises and medications that counteract spasticity tend to be effective treatments that reduce the loss of mobility.
– Loss of balance: Problems that are associated with balance tend to make people walk in a wobbling manner (ataxia). Severe cases of ataxia may require aid devices that facilitate mobility.
– Lack of sensitivity: Some people experience numbness (lack of sensitivity) in their feet such that they either cannot feel the ground or cannot sense exactly where their feet are while they are walking. They may also notice a lack of sensitivity in their hands, which makes moving them difficult. This phenomenon is called “sensory ataxia.”
– Fatigue: Mobility problems are aggravated when the patient is tired. Fatigue is inherent with Multiple Sclerosis . It appears before and is felt to a greater extent in MS patients as compared to healthy persons and is aggravated by high temperatures.
Why does loss of mobility occur?
How do the skeletal muscles normally function and coordinate themselves during movement? The orders for voluntary movement originate in the cerebral cortex, whereas involuntary movements (reflexes, jerking your hand out of a flame…) originate from lower levels of the nervous system. Muscle or motor coordination is the ability of the body’s skeletal muscles to synchronize themselves with respect to direction and movement.
Movement occurs as a result of coordinated and efficient muscle contractions, in which not only the necessary muscles, but the joints and nerves etc. act as well. Muscle coordination is a result of integrated nervous system, skeletal, brain and spinal cord function. In addition, the cerebellum processes the information that allows for more fine-scale, precise movements.
In Multiple Sclerosis, these messages are not transmitted properly because the paths between the brain, the spinal cord and the muscles are damaged. The messages are scrambled and several muscle groups contract at the same time when they should not. Precise motor control is lost progressively and simultaneous contraction of the extensor and flexor muscles leads to a lack of coordination, often with painful and debilitating results.
As with all symptoms associated with MS, loss of mobility is the result of the progressive degradation of myelin and of the nerve fibers. This disrupts the transmission of nerve signals to the muscles responsible for mobility and, as a result, these muscles do not receive the appropriate orders to contract. At the same time, damage to the upper motor neurons that control muscle tone (rigidity) and reflexes is occurring, which generates continuous muscle contraction (including spontaneous contractions like spasms) and affects the joint reflexes. Finally, damage to the cerebellar path affects the coordination of movement. All together, these result in a loss of mobility.
Loss of mobility occurs in approximately 91% of Multiple Sclerosis patients. It tends to appear early, mildly at first, and becomes progressively worse.
Loss of mobility treatments
Your physician will determine whether any of the available drugs used to treat these problems (like muscle relaxants…) are appropriate for your situation.
- Devices that support mobility
In the early stages, no help will be needed. However, as the disease progresses, the use of aids like canes, crutches, walkers and/or wheelchairs will be necessary. Medical equipment is available to help you.
– When there are balance problems, weakness, spasticity or fatigue, the use of one or two crutches can help you walk more safely on your own. The use of crutches, in addition to helping you walk and reducing the risk of falls, will allow you to get exercise and reduce the severity of your spasticity and fatigue symptoms throughout the day.
– In some cases, when balance or weakness problems are more severe, the use of a walker may be recommended, in order to provide you with more stability. The use of walkers with two front wheels are usually recommended as these are more comfortable to walk with without sacrificing stability.
– On the other hand, either with or even without these aids, you may be able to handle short distances well but will have problems with longer distances or when you are away from home for many hours at a time. In these cases, it is best to have a wheelchair on hand that you can use when needed. However, you will have to determine whether an electric or manual wheelchair is best for you.
1.US National Multiple Sclerosis Society, MS symptoms: http://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms
2.Drs. M. Murie and E. Moral (2011): Espasticidad en Esclerosis Múltiple, ISBN: 978-84-15198-27-7, Luzán 5, S.A., Madrid, Spain
This general information is not intended to diagnose any medical condition or to replace your healthcare professional.
You should consult with your health care professional for specific advice relating to your medical questions or condition. Only your practitioner can completely and appropriately assess your situation and make conclusive decisions regarding your care.