Multiple Sclerosis - A Practical Guide to Rehabilitation - 14

AIMS

A PRACTICAL GUIDE TO IDIOPATHIC PULMONARY FIBROSIS

Mobility
Mobility is a critical dimension of
independence, and loss of mobility is
indicative of disease progression in MS.
People with MS rate ambulation in
particular as their most important
function,40 yet an estimated 75% have
walking disturbances, with some
limitations present early in the disease
course.41 Primary symptoms of MS such as
weakness, spasticity, balance and
coordination difficulties, fatigue, and
sensory deficits can impair mobility, as
can as cognitive dysfunction, bowel and
bladder issues, and pain. Limitations in
mobility may directly impact participation
in the community, occupational pursuits,
and family activities. Further, increasing
disability and reduced mobility can affect
health generally, and may contribute to
skin breakdown, risk of pneumonia, and
cardiovascular disease.

14

Figure 4: Expanded Disability Status Scale (EDSS)42
DEATH
10
9
8
7
6
5
4
3
2
1

Increasing Disability

Weakness, spasticity, and impaired balance can
impact mobility in persons with MS. Weakness
and spasticity are associated with gait deviations
such as circumduction, vaulting to clear a weak
leg, genu recurvatum, foot drag, shuffling feet,
lateral trunk flexion, and decreased
push-off/acceleration. When developing
rehabilitation plans for patients with MS, the
inter-relatedness of multiple factors affecting
mobility should be considered with all
assessments.

Measures for evaluating mobility in ambulatory
patients include the Timed 25-foot Walk (also
part of the MS Functional Composite), the Timed
Up and Go (TUG), the 2- and 6-Minute Walk
Tests, the Dynamic Gait Index, and the 12-Item
MS Walking Scale (MSWS-12), a self-report
measure of walking ability that is strongly
correlated with the EDSS.43,44 Walking tests are
typically performed in a tiled hallway of ˜60 feet
in length and free of obstruction. Each of these
measures is described briefly below.

Numerous measures can be used in clinical
practice to evaluate mobility in MS. One is the
Expanded Disability Status Scale (EDSS)
(Figure 4). Higher scores on this assessment
correspond to greater limitations in mobility. For
example, a score of 6.0 indicates a need for
unilateral device for ambulation), 7.0 indicates a
need for a wheelchair, and 8.0 indicates
restriction to a bed or chair.42

Timed 25-Foot Walk: Subjects start at a line on
the floor and are instructed to "walk as quickly as
possible, but safely," beyond a second line on the
floor (25 feet away). Time is recorded in seconds,
starting with the first heel strike beyond the start
line and stopping at the first heel strike beyond
the second line. Two trials are performed, and the
faster trial is used for analysis.

Mobility



Multiple Sclerosis - A Practical Guide to Rehabilitation

Table of Contents for the Digital Edition of Multiple Sclerosis - A Practical Guide to Rehabilitation

Contents
Multiple Sclerosis - A Practical Guide to Rehabilitation - Contents
Multiple Sclerosis - A Practical Guide to Rehabilitation - Cover2
Multiple Sclerosis - A Practical Guide to Rehabilitation - 1
Multiple Sclerosis - A Practical Guide to Rehabilitation - 2
Multiple Sclerosis - A Practical Guide to Rehabilitation - 3
Multiple Sclerosis - A Practical Guide to Rehabilitation - 4
Multiple Sclerosis - A Practical Guide to Rehabilitation - 5
Multiple Sclerosis - A Practical Guide to Rehabilitation - 6
Multiple Sclerosis - A Practical Guide to Rehabilitation - 7
Multiple Sclerosis - A Practical Guide to Rehabilitation - 8
Multiple Sclerosis - A Practical Guide to Rehabilitation - 9
Multiple Sclerosis - A Practical Guide to Rehabilitation - 10
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Multiple Sclerosis - A Practical Guide to Rehabilitation - 12
Multiple Sclerosis - A Practical Guide to Rehabilitation - 13
Multiple Sclerosis - A Practical Guide to Rehabilitation - 14
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Multiple Sclerosis - A Practical Guide to Rehabilitation - 65
Multiple Sclerosis - A Practical Guide to Rehabilitation - Cover3
Multiple Sclerosis - A Practical Guide to Rehabilitation - Cover4
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