8个步骤与MS更好地行走| Everyday Health

患有多发性硬化症（MS）的人中有八十位在疾病发作后的10到15年内经历了行走的问题，according to the National Multiple Sclerosis Society (NMSS)。Furthermore, commonsymptoms of MS，包括弱点，平衡差，痉挛和疲劳，可以增加跌倒的风险。

然而,这并不意味着女士的人need to give up on being able to get around on their own. Indeed, experts suggest many ways thatpeople with MScan work to maintain their mobility for as long as possible.

“Difficulty walking is among the most common of the symptoms that first bring a person with undiagnosed MS to the clinic,” notesAlexius E.G. Sandoval, MD, medical director of the multiple sclerosis rehabilitation program at Johns Hopkins in Baltimore.

“It’s often the first noticeable symptom, and while we still can’t cure or reverse MS, we can help maintain the function that you do have, use compensatory strategies, and keep you moving for as long as possible,” Dr. Sandoval says.

Here are eight things you can try to stay mobile with multiple sclerosis:

1. Physical Therapy

In physical therapy (PT), therapists evaluate the body’s ability to move and function, then look for strategies to strengthen or compensate for weaknesses or other problems.

Valerie Block, adjunct instructor of physical therapy at the University of California in San Francisco’s Weill Institute for Neurosciences, says physical therapy for a person with MS might include a program of exercises and stretches, as well as training in using walking aids like拐杖拐杖,摩托车,或轮椅。The idea, she says, is to keep you safe while restoring confidence in your legs and balance.

2.Occupational Therapy

Although occupational therapy (OT) is a separate discipline from PT, Block says that its goals are essentially the same: increasing independence, safety, and quality of life during daily activities such as personal care, hobbies, family life, and work.

To facilitate walking, Block says occupational therapisths usually work with physical therapists to train people with MS to use assistive devices and to simplify tasks at home.

Ideally, Sandoval adds, therapists may visit a patient’s home to perform a home evaluation and offer advice on what people with MS can do tomake their homes safer, more accessible，并且与他们的局限性和需求兼容。

“We may advise people to remove rugs or pieces of furniture they can trip over or to install ramps and grab bars,” he says.

3.Aerobic Exercise

Historically, Block says, it was thought that exercise was bad for people with MS because it can increase the fatigue they often experience. However, she says, now it’s generally accepted that a customized exercise program tailored to the needs of the individual can help improve energy levels as well as endurance, balance, and strength, all of which can lead to better walking and better overall quality of life.

While the types of exercises recommended differ from person to person, those aimed at improving walking generally focus on maintaining muscle strength in the legs and, if necessary,weight loss, Block notes.

“Maintaining a healthy weight is crucial in MS,” she says. “The less weight you carry around, the less strain on the legs and the better balance you have.”

A review and meta-analysis published in April 2021 in theArchives of Physical Medicine and Rehabilitation发现这两者有氧运动training andresistance trainingare equally highly effective at improving lower extremity physical function and fatigue in people who have MS.

另一项研究，于2021年6月发表在Annals of Clinical and Translational Neurology，发现耐药性训练导致MS患者的代谢变化，这些变化与髋关节强度改善，步行距离和速度增加以及疲劳减轻有关。

4. Walking Aids for Mobility and Independence

Although the goal of mostMS treatmentplans is to maintain mobility without the need for assistance for as long as possible, many people who have MS will need to use an assistive device at some point.

Sandoval recommends working with a multidisciplinary team of specialists — including physicians,physical therapists, occupational therapists, and orthotists (specialists who fit orthotic devices or braces) — to choose and learn to use the right device.

“People are usually initially resistant to using things like canes to get around,” Block says. “People see reliance on assistive devices as a loss of freedom. But these devices can actually help people maintain their freedom by enabling them to get around safely.”

一项研究于2021年6月发表的研究International Journal of MS Carecompared assistive devices used by people with MS and found that participants reported more positive psychosocial impact, and walked faster and with higher quality, with the single-point cane and a trekking pole than with a four-point cane.

5.Working With a Podiatrist

The services of a podiatrist or other foot-care specialist may be helpful as well. Foot health can sometimes be a serious issue for people with MS, Sandoval says, and podiatrists can help in a number of ways, from trimming toenails (if you can't do it yourself) to treating footulcers。Podiatrists can also recommend shoe inserts or prescription shoes as needed.

6. Botox to Reduce Spasticity

According to Sandoval, Botox (Onabotulinumtoxina) is often used to treat a spasticfoot drop, in which certain muscles in the leg and foot abnormally force the foot downward, disrupting the natural heel-to-toe gait. If you have this type of foot drop, your doctor may try to correct the problem by injecting Botox into the spastic muscles that force the foot downward.

The injections must be performed by a trained medical professional, and the effects of Botox usually last about three months, so injections are repeated when necessary to maintain the desired effect.

“The side effects are minimal if the injections are performed properly,” Sandoval says.

7. Functional Electrical Nerve Stimulation

For some types of walking problems, afunctional electrical stimulation (FES) devicecan help,根据NMSS。FES设备将温和的电刺激传递到肌肉，这有助于它更好地移动。这可以帮助某些问题，例如脚下和下肢弱点。

The goal, Sandoval says, is to facilitate and retrain muscles to perform their intended function.

“Unfortunately, the device is expensive and often not covered by insurance,” Sandoval says. But for properly selected individuals, it can work really well and can be more convenient to use than a brace.

8. Medication for Walking Help

Most medications prescribed to help people with MS walk better are designed to address specific symptoms that make walking difficult, such as fatigue, pain, or muscle spasticity.

One drug, calledAmpyra(dalfampridine), is approved by the Food and Drug Administration specifically to improve walking in people with multiple sclerosis. Ampyra comes in tablet form and is thought to improve the transmission of signals along nerves damaged in MS.

“It works well in about a third of MS patients, with minimal side effects,” Sandoval says.

A meta-analysis published in February 2021 in theOrphanet Journal of Rare Diseasesfound that dalfampridine has a positive effect on walking ability, finger dexterity, and cognitive function.

However, Block says that some people with MS “are wary about taking medication, because MS is a lifelong disease.” As a result, many specialists will recommend other approaches, like PT, OT, exercise, and orthotics, as a “first line of defense,” Block notes.

Regardless of what method or methods you choose, experts emphasize that it’s vital to follow the prescribed treatment plan. If you do, you should see the benefits.

“Because MS is a progressive disease, people too often get stuck on what they can’t do,” Block says. “Our job is to show them what they can do, and how these tools can help them get through their day.”