Mobility and Walking Issues
The United States' Food and Drug Administration (FDA) approved Ampyra® (dalfampridine) in 2010 to improve walking speed in individuals with MS. This is the first drug to be approved for individuals with MS whose ability to walk has been impacted by the disease. Ampyra is an oral, timed-release medication developed to improve the conduction of impulses between damaged nerves of the central nervous system (CNS). Phase III clinical trials showed that a greater number of individuals with MS experienced improvement in walking speed when taking Ampyra, compared to when taking a placebo.
Ampyra (pronounced "am-PEER-ah") was developed by Acorda Therapeutics and is manufactured by Elan Corporation. Formerly known as Fampridine-SR, Ampyra is a sustained-release version of 4-aminopyridine (4AP). In earlier studies, larger doses of the drug were given and the risk of seizures became a concern. Given in extended-release tablets, the risk of seizures did not differ from the placebo group.
MSAA Chief Medical Officer Jack Burks, MD explains, “Following the instructions for correct dosing is absolutely essential. Taking more than one tablet within 12 hours, or crushing or splitting a tablet, will increase the risk for seizures. Some patients tend to think that taking more of a symptom-management drug will result in greater effectiveness, but this is definitely not the case with this type of medication.”
To read more about this drug and its study results, please see MSAA’s article, “Ampyra Approved to Improve Walking for Individuals with MS.”
Side effects included dizziness, falls, back pain, insomnia, fatigue, nausea, and balance problems.
Mobility Independence and Safety
MSAA has published a series of three informative articles on Mobility Independence and Safety, all written by Patricia G. Provance, PT, MSCS – a physical therapist who specializes in rehabilitation for individuals with MS. To follow is a brief introduction to each of these topics in the series, along with links to the full articles.
Part I: Ambulation
When we hear the word "mobility," most thoughts turn to walking. However, being mobile amounts to much, much more. If we think back to how we developed, we first learned to roll over, sit up, crawl, pull up and stand steadily before we started to walk. As many people challenged with the rainbow of symptoms associated with MS have discovered, maintaining safe and independent mobility can sometimes be difficult.
Unfortunately, the result is often a marked decrease in overall activity – which leads to preventable disuse weakness and de-conditioning. If the downward spiral from inactivity continues, other problems can develop. These include: muscle tightness and/or weakness; increased spasticity; bowel problems (usually constipation); decreased heart and lung function; pressure sores; depression; and social isolation.
Everyone should have the goal of achieving, and then maintaining, the highest possible level of independent function. This includes safe mobility – both at home and in the community. Since the primary goal of most individuals with MS is "to keep walking" or "to walk better," this first of three articles will focus on issues related to gait (ambulation).
My recommendation is for everyone with MS to receive a baseline evaluation from a physical therapist (PT) experienced in MS care. Ideally, this should be done soon after diagnosis - but at the very least, at the first sign of problems with balance, walking, or endurance.
Part II: Improving Functional Mobility with Exercise
In the past, many physicians recommended rest instead of activity because of fatigue issues and the fact that MS was a "progressive" neurological disease. However, research in the past 10 years has shown that well-paced exercise and activity can, indeed, result in positive outcomes relating to improved functional strength, endurance and quality of life.
As a PT, I have many times heard the refrain, "Why exercise? I have MS!" Burdened by sometimes overwhelming fatigue and frustration, many individuals with MS feel that exercise will just make their situation worse. In fact, that could be true - especially if the exercise or activity is not appropriate or is "overdone." Unfortunately, some therapists and trainers who are not familiar with MS (especially the symptom fluctuations, fatigue issues, and heat sensitivity) will unknowingly push you to failure and more frustration.
My desire in writing this article is to help you become an informed advocate in developing your own, customized, exercise and activity program. The guidance of a PT with experience in MS care can be helpful – but there are many things you can do on your own. However, before starting, some planning is necessary. Here are some questions to ask:
Part III: Wheeled Mobility
With today’s long-term treatments and valuable rehabilitation methods, including physical and occupational therapies, far fewer individuals require the assistance of a wheelchair or scooter. However, for individuals whose mobility has been affected, using “wheeled mobility” can greatly help to save energy as well as increase safety – and information about specific equipment can be extremely useful.
The author notes that it is not possible to include all of the wheeled-mobility options in a short article, so the emphasis has been placed on outlining the many factors to be considered. This includes the pros and cons of each type of equipment, as well as resources to further your education.
Individuals with MS who require wheeled mobility most or all of the time should be evaluated by a seating specialist, usually a physical therapist (PT) or occupational therapist (OT) with extensive training in this area. Preferably, this should be done in a "seating clinic," also attended by a family member and/or care partner, along with a rehabilitation technology supplier (RTS) representing a durable medical equipment company. This will help ensure that the most appropriate device is prescribed for each individual situation.
|Last Updated on Wednesday, 16 October 2013 12:43|