How common is it for a person with MS to have problems walking?

According to the National Multiple Sclerosis Society, an estimated 2.3 million people have multiple sclerosis and that number continues to grow worldwide every year.  Problems walking is the most common cause of falls and injuries. Statistics show that approximately 50-70% of people with MS fall on a regular basis.

A recent study, conducted by scientists and physicians in accordance with the National Multiple Sclerosis Society reported that nearly 30% of people who reported falling, fell several times, which all resulted in an injury of some type.

Enhancing an individual’s ability to walk safely while preventing a fall, is crucial. Not only do falls cause injuries, the time necessary to recuperate from strained or sprained muscles or broken bones can make walking (gait) problems worse and reduce the person’s independence.

What are the top fall risk factors?

People with MS generally fall inside their home, but that is not say that the risk of falling decreases outside, at work or while out in the community.

Falls are most common when people are doing everyday activities such as; bathing, dressing, cooking, cleaning, or walking in unfamiliar areas or crowds outside the home.

Risk factors for falls are multifaceted and can include the following:

• Slow walking
• Balance problems
• Problems with sensation of where your body is while waking (example – If the person is unable to fully feel their feet on the group they are more likely to under or over step and fall)
• Neurological problems if a person is unable to judge where their body is in relation to a wall, stairs, a street sign, curb etc. (because the signal from the brain to the body is interrupted) a fall is likely
• Medications, some medications can make the person dizzy, or affect the message system and the person may perceive something to be closer or further away than it is
• Incorrect use of canes or walkers or trying to walk without an assistive device

What are some strategies to help prevent falls?

There are several self-management strategies a person can use to help prevent the risk of falling.

• Take close look at your home and identify anything that could possibly pose a fall risk. Once they are identified “fall proof” them. For example; Throw rugs are a fall hazard for everyone, not just people with MS – either get rid of throw rugs or secure them to the floor so they do not unexpectedly move while you are walking across them.
• Always use the correct mobility device whether it be a cane or a walker, this will decrease your risk of falling greatly.
• If you fall more often when you are tried, then try to limit your walking or walk with assistance during those times.
• If your medication makes you dizzy or unsteady, plan to sit for a period of time, until you know it is safer for you to be up and moving around.
• If you are experiencing severe weakness in your lower body, going to be in a crowd, walking a long distance or for a long time or any situation where you feel walking may be a problem use a wheelchair or scooter.

Prevalence of speech disorders

41-51% of MS Warriors may experience symptoms of dysarthria according to a number of studies reported by the National Multiple Sclerosis Society. These studies have relied on a clinical diagnosis for speech disorders. When self-reporting is used, the prevalence of speech disorders varies.

Study conducted in United States and published in 1985

• Dysarthria prevalence: 23%
• Cohort size: 656 people with MS

Study conducted in Sweden and published in 1994

• Dysarthria prevalence: 44%
• Cohort size: 200 people with MS

Preliminary study conducted in South Africa and published in 2002

• Dysarthria prevalence: 57%
• Cohort size: 30 people with MS

Symptoms of dysarthria

Dysarthria is categorized by slow and/or slurred speech that is often difficult for other people to understand. With dysarthria, there are both vocal symptoms and physical/neuromuscular symptoms. Common symptoms include:

• Slurred speech
• Speaking too rapidly or too slowly
• Speaking too loudly or too quietly
• Raspy, strained speech
• Speaking with an abnormal rhythm or with uneven volume
• Monotone speech
• Jaw-jerking reflexes
• Irregular eye movements

Causes of dysarthria in MS

Dysarthria is caused by a neuromuscular impairment that causes instabilities in the brain that regulate the motor control of the speech system. People with MS can develop lesions throughout the brain, including in the parts of the brain that control speech: the left hemisphere of the cerebrum and the brainstem.

In addition to the impact of lesions, MS also causes weakness, spasticity (stiff muscles), sluggishness, and ataxia (issues with muscle coordination). Ataxia can impact the coordination of the parts of the body needed for speech including the tongue, mandible, lips, vocal cords, soft palate, and diaphragm.

These different mechanisms result in speech disorders having a wide array of symptoms and underlying causes. Because of this, there are 3 types of dysarthria that can result from the location of lesions in the brain. The three types are:

1. Ataxic
   • Caused by generalized or bilateral lesions on the cerebellum
2. Spastic
   • Caused by bilateral lesions of the neuron pathways
3. Mixed
   • Caused by generalized or bilateral lesions of the cerebellum, white matter, spinal cord, and/or the brainstem

Symptoms of dysphonia

In slight contrast to speech disorders, dysphonia is a vocal disorder. Dysphonia is the scientific name for hoarseness or having a hoarse voice.

Symptoms are often changes to the quality of the voice including the voice being:

• Harsh
• Nasally
• Hoarse
• Breathy

Causes of dysphonia

In dysphonia, the larynx (voice box) functions improperly as air moves through it. When functioning properly, the vocal folds are moved toward the midline of the vocal tract by exhaled air. This also causes vibrations of the vocal folds which produce the voice.

There are a number of causes of dysphonia including vocal abuse. If you’ve lost your voice from cheering or yelling, you have experienced dysphonia. This isn’t the only cause, though. Neuromuscular issues, including multiple sclerosis and Parkinson’s disease, growths and polyps, allergens, and systemic diseases can also cause symptoms.

Treatment options for speech disorders

If you believe you are experiencing any signs or symptoms of speech disorders, you should talk through your concerns with your MS Treatment Team.

There are a number of exercise and strengthening exercises that can be used to help people with MS battle:

• Biofeedback
  • A gauge that can measure elements of the voice (including loudness and phrase length) during speech
  • Helps with breath control and breathing patterns during speech
• Exercise the muscles
  • Strengthening the muscles associated with speech including the tongue, mandible, lips, vocal cords, soft palate, and diaphragm improve speech
• Speech therapy
  • Speech pathologists have created programs to help overcome specific symptoms associated with speech disorders

Primary fatigue

Primary fatigue is defined as fatigue caused by damage to the central nervous system including the brain, brainstem, and spinal cord. This damage can be caused by either inflammation or demyelination.

Many scientists and researchers believe that the fatigue is caused as a result of how the brain adjusts to the impact of MS.

Doctors have conducted MRI scans on people who have MS fatigue to try and learn more about this symptom. The results indicate that these individuals use a much larger area of the brain to carry out everyday activities than people without MS related fatigue. Scientist believe this could be an indication that the brain is trying to find new pathways for the messages to travel through when the normal pathways have become affected.

More research is needed to better understand the full range of primary mechanisms that are responsible for this symptom. To date, the 3 most discussed mechanisms are:

• Cytokine influences
  • Interferon-γ
  • TNF-α
• Endocrine influences
  • Hypothalamic-pituitary-adrenal (HPA) axis
  • Hormone dehydroepiandrosterone (DHEA)
• Axonal loss and altered cerebral activation
  • See above with the MRI research which examined neural pathways

Secondary fatigue

Secondary fatigue is thought to be the result of issues that are related to multiple sclerosis, but are not directly caused by the disease. These include:

• Muscle weakness
• Acute and chronic pain
• Depression
• Tremors
• Stiffness
• Bladder incontinence
• Lack of sleep or broken sleep
• Muscle cramps and spams
• Medications

Many people who suffer from MS also experience anxiety and depression, which can make a person feel more fatigued than normal.

Additionally, fatigue is a common side effect of many medications used to treat MS. Always be mindful of any medications that you take and be sure that you are taking them as prescribed. If you are taking non-prescribed medications, including over-the-counter drugs, be sure to share that information with your doctor as the medications can have different side effects when they are mixed.

NOTE: Always speak with your multiple sclerosis treatment team about physical symptoms and issues of mental health. Your clinicians can help connect you to resources and health providers in your area.

Tips for managing MS fatigue

As is common with many chronic conditions, maintaining a healthy lifestyle will help decrease the severity of many symptoms. Eating healthy foods – particularly lean meats, fruits, and vegetables – can influence your energy levels. It can be useful to track the foods that you eat to get a better understanding of the source of the calories that you eat.

In addition to eating habits, the following are good strategies to help battle fatigue:

• Exercise
  • Walking, swimming, stretching, and other gentle exercises can be very useful
• Take naps
  • Even if you don’t sleep, resting can help
• Pace yourself
  • Building in time to rest during activities
• Manage stress
  • Music therapy, art therapy, and other stress relieving exercises can provide relief from stress
• Be patient with yourself

Looking for tips and tricks on how to battle fatigue? Check out support groups online and in-person.