ALERT Mobilit y
Q:Taking steps toward better gait
by Laura Putre
Cecilie Fjeldstad, PhD, an exercise physiologist and senior researcher at Sisters of Mercy Health System in Oklahoma City, has been
studying gait problems related to multiple sclerosis
How does MS a;ect a person’s gait?
The neurological impairment that occurs
in MS can affect multiple components of the
nervous system, including both the sensory
and motor systems as well as the cerebellar system,
which regulates coordination. If all the components
of the nervous system are not working together
properly, a person may display spasticity, muscle
weakness or vision disturbances, any of which can
lead to impaired gait.
The most common gait problem in MS is foot
drop. This weakness in the ankle occurs when the
nerves don’t properly tell the muscles to flex, and
the person has trouble lifting one or both feet. Foot
drop alone can alter the mechanism of gait and lead
to knee and hip joint pain as well as increased risk
Spasticity, or an excess of muscle tone, can also
significantly affect the ability to walk, even if you
don’t have muscle weakness.
What kind of doctor should people with
MS see for walking problems?
Usually a neurologist will address MS
comprehensively. The neurologist may refer
a person to other providers, such as a physiatrist
(a physical medicine and rehabilitation doctor),
an orthopedic surgeon, a physical therapist or an
How do you determine what course of
treatment to take?
We have to figure out exactly why someone
is having difficulty walking and whether that
difficulty can be helped through medication or
assistive devices like electronic stimulators.
Increasing muscle strength through
physical activity can be very beneficial. Usually
with physical activity, we see an improvement
in gait and an increase in balance. We also see
an increase in quality of life and a decrease in
depression. But anyone starting any kind of