Multiple sclerosis (MS) is a progressive neurologic disorder which is characterised by a gradual degeneration of the central nervous system and diffused inflammatory demyelination.
There are significant alterations observed in a patient’s gait as a result of neurological deficits such as motor weakness, hypertonia, decreased muscular strength and spasticity; limitations in ambulation caused by MS considerably affect an individual’s quality of life.
While discussing gait variability observed in patients with MS, Socie and Sosnoff mention an increase in signal noise within the neuromuscular system, hyper-exaggerated stretch flex and fatigue as potentially contributing to gait impairments.
Güner et al. attribute muscle weakness in patients with MS to a loss in mobility and upper limb function, alterations in posture and placement of abnormal levels of stress on many of the structures essential for ambulation.
The lower extremity undertakes compensatory movements which result in shorter stride length, a slower walking speed, prolonged double support phase at a decreased cadence and reduced joint motion.
A reduction in muscle strength, proprioception and balance are common in elderly individuals with MS, elevating their susceptibility to falls and necessitating interventions to prevent complications caused by these falls.
Early intervention and treatment strategies for MS are important because of the burden of disability and premature mortality in addition to the substantial economic costs that are normally associated with the condition.
For this purpose, Ziemssen et al. advocate monitoring MS disease activity with the following three elements as a key to achieving optimal outcomes – disease activity as manifested in relapses (reflecting inflammation), disability (reflecting neuroaxonal loss) and functionality (reflecting the degree of compensation or cerebral reserve).
The authors describe a limited time frame to effectively intervene in patients with early MS; an intervention during this period can be critical for achieving favourable long-term outcomes while allowing for prompt switches in case of treatment failure.
A study clearly established the efficacy of a tailored, integrated physical rehabilitation programme on the ambulation of MS patients by obtaining data from patients who participated in a 3-week, goal-directed rehabilitation programme.
The personalised rehabilitation programme included three major components which were modified according to the patient’s specific impairments and functional needs – goal directed physical therapy, moderately intense aerobic exercise training on a bicycle ergometer and aquatic therapy chiefly oriented to body structures appropriate to movement.
At the end of the programme, an increase in both walking speed and gait velocity was achieved despite the level of disability of the patient; the findings of this study can be helpful in the formulation of successful functional programmes for MS patients.
In addition to this, a detailed lower limb assessment can be performed to identify underlying foot postural disparities and to facilitate the implementation of custom foot orthotics as a measure for further preventing limitations in mobility.
MASS4D® foot orthotics can be used to augment early treatment efforts for MS by providing the correct balance of a resistant force to allow optimal muscle function throughout the functional range of motion while coaxing weaker muscles into strengthening and re-establishing joint alignment.
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Repetitive plantarflexion can lead to pain and mechanical limitation in the posterior ankle joint which is known as posterior ankle impingement syndrome. This pathology commonly occurs in ballet dancers and football players.