ALERT Mobilit y
tion; if spasticity is the main culprit, PTs teach
Physical therapists also coax people to try
assistive equipment. Canes, walkers, scooters, and
orthotics, such as an ankle-foot orthosis (AFO),
can make a huge difference, although it takes most
people time to accept these options as tools to
help them do what they want to do, rather than as
symbols of loss.
“Proper bracing of a limb in conjunction with
PT may also help prevent serious secondary complications, like contractures (frozen joints),” Dr.
Mobility problems can be also treated with medication, sometimes to great effect.
Baclofen and tizanidine. “Muscle relaxants like
baclofen and tizanidine can be very helpful if spasticity or spasms are a significant issue,” Dr. Boissy
said. Baclofen is an oral drug, but if higher doses
are needed, a baclofen pump is an option that will
avoid the debilitating fatigue that may come with
high doses of oral baclofen. The pump is placed in
the abdomen and an internal catheter delivers the
drug into the space around the spinal cord.
Botox, or botulinum toxin, is another option
for spasticity management. This drug paralyzes the
muscle and is given as an injection into specific
“Botox often relieves painful spasms but it may
not necessarily improve mobility, so it’s important
to have good communication about this decision
and clear expectations amongst all parties,” Dr.
Ampyra. Ampyra (fampridine SR) is a newer
option available for problems related to both
weakness and spasticity. “Ampyra helps the
nerves—and makes it possible for them to con-
duct better,” Dr. Boissy said. “It can be a good
add-on therapy for people who are on their feet,
but who want to be more mobile.”
For Patti Substelny, 42, a former bank vice presi-
dent from Cleveland, Ampyra was a breakthrough.
“I can control my legs better than I have in years,
and I’m a lot more flexible,” she said. Substelny was
diagnosed with MS 13 years ago. She had been on
Avonex before switching to Tysabri. Later, she tried
Botox to combat spasticity. “I found it very difficult
emotionally—I didn’t like the injections.” With
Ampyra, “I do have weakness, but it makes things
more possible for me. I don’t need ‘easy’—I need to
feel like things are more possible.”
However, Ampyra does not do well for every-
one. Katy Spritzer, 44, a commercial real estate
investment manager in Denver, began experienc-
ing increased weakness from her MS last year. “By
summer my walking was just getting tedious,” she
said. “When it was hot, I would look down the
block and think, ‘I don’t know if I can get there.’ ”
When she heard about Ampyra, she and her
doctor decided to add it to her regular MS drug.
“I knew there was a risk of seizures, so I was a
little scared,” she said. “I was on it for about a
week when I started getting migraines. I couldn’t
sleep—it was making me feel really weird. So I
stopped.” After Spritzer’s physician treated her
with IV steroids, her walking got better, and she
now thinks her problems were the result of an
attack rather than disease progression.
“While there are medical and therapeutic options
to improve mobility,” Dr. Boissy said, “the lack of
mobility in MS is not a mechanical problem that
surgery can fix. We reserve surgical treatment for
complications like contractures that occur due to
prolonged immobility, or to implant a baclofen
Dr. Boissy emphasized that whether people
with MS use physical therapy, assistive equipment,
medication, surgery—or combinations—to keep
moving, the key is to prioritize choices around
what the individual wants to continue to do.
Nothing is more important.
Emily Wojcik is a freelance writer and college instructor
living in Northampton, Mass.