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Here is My Question:
What would be considered "normal" amount of trips/falls? In the past 30 days I have broke a finger at the joint, broke a toe, and acquired a nasty burn while cooking.. I use a variety of mobile devices depending on the day's needs. I try to find balance between doing what I can without aid, and using aid when it is necessary. How does one challenge themselves, and not get hurt so often? I am not willing to "throw in the towel", and feel if I don't fight with all I have, I will be full time wheel chair sooner than necessary. Am I thinking incorrectly? Answer: The honest answer to your question is that no falls would be the “normal” amount of falls for someone to have. Having had 3 falls in one month is concerning, especially because you have had some injuries as a result of the falls. My first recommendation is to ask yourself a few questions:
I also recommend you call your neurologist and report the recent increase falls as well as your injuries. If you are having new MS symptoms you should report those as well. If you aren’t having new symptoms, it is still important to determine the potential causes of your falls, so you can correct them! There are a lot of different reasons why you may be falling, and it is important to determine what the reason is. The neurologist can rule out a medical cause of the falls (MS exacerbation or medication changes) and can also refer you to a physical therapist. A physical therapist can help determine non-medical reasons for why you might be falling (muscle weakness, impaired gait or impaired balance) and teach you ways to help prevent falls in the future. Often times preventing a fall can be as simple as making modifications to your environment, or being more mindful of what you are doing. Sometimes it’s a matter of using the “right device/aid” depending on the task you are doing! I certainly can understand your mindset of “not wanting to throw in the towel” but there are definitely ways you can be safer without giving up and becoming wheelchair bound!!! The following link will provide a PDF brochure from the National MS Society which provides excellent information about minimizing risk of falls! It provides information on reasons why people fall and how you can modify your environment and daily activities to minimize your risk of falling! It is a wonderful resource, but would best be used in conjunction with physical therapy! http://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Brochures/Brochure-Minimizing-Your-Risk-of-Falls.pdf Falls are not something to be taken lightly! As I tell my patients; you have enough to manage with your MS alone, you don’t need any broken bones or head injuries on top of that!!!! I hope this helps answer your question, and gives you faith that you can be safe without giving up your mobility and independence! Hope this helps. Sarah Wargo,PT,DPT,MSCS Outpatient Rehab Mt. Sinai Rehabilitation Hospital 490 Blue Hills Ave. Hartford, Ct. 06112 Question:
When/why does one need to start using a cane? I have no significant difficulty with ambulation for more than 30 minutes on a treadmill though my right leg gets fatigued with any incline and I have trouble carrying anything upstairs. I did not consider this a major problem but I have fallen 3 times in the last 6 months with minor injuries. My new neurologist suggested I consider using a cane. I feel that my falls are due more to attention lapses than problems with my legs even though I really try to be careful and pay attention. How would a cane help this? Answer: There are many different reasons one might begin to use a cane. One of them certainly is falls. There are many factors that might contribute to a fall, but if you are falling frequently, or having near falls frequently, it might be time to consider the use of a walking aide. Another reason to start using a cane is if you begin to notice a change in the way you are walking. For example, if you are starting to walk with “a limp” it might be time. If you are starting to have pain in your legs, or your back when you are walking, it might be time to consider using a cane. Another big indication that it may be time for a cane (or other device) is if you begin to rely on walls or furniture when you are walking. This is a huge indication that you are already seeking out support from an external source, so a cane or device would be helpful for you. Regardless of the scenario, if you have been considering using a device, or if it has been recommended to you; I would STRONGLY recommend you seek out the advice of a physical therapist. There are MANY different types of assistive devices (like a cane) out there, and there are many ways to use them. Choosing the right one for you, and using it appropriately, is of utmost importance for your safety. A physical therapist will be able to help decide what device is best for you, and will be able to show you how to use it correctly. Additionally, a physical therapist can help determine what is causing the changes in your walking ability, and may be able to help you fix it! It could be muscle weakness, changes in balance, or inadequate flexibility. So, if you think you might need a cane, let a physical therapist help you! Here is a blog to read on how to find a physical therapist who is knowledgeable about MS: READ MORE Sarah Wargo, DPT Outpatient Rehab Mt. Sinai Rehabilitation Hospital Here is My Question:
I have severe leg weakness following a left femur fracture 6 months ago. I want to start physical therapy soon to help me walk better in my walker. I mainly use a wheelchair now. Before the accident I did not have a wheelchair. What kind of shoes should I have for PT? My doctor said I will walk again but I have to help myself. I have had MS for 15 ears and am 67 years young. I want so to improve my life. Thank you, lynn Answer: So glad to hear that you are starting physical therapy and are motivated to help yourself! Sarah Wargo DPT, MSCS at the Mandell Center for Multiple Sclerosis says that sneakers would be best. This will allow you to participate in any standing or walking activities with good foot support and traction on the floor. Additionally, it will allow the therapist to trial any type of assistive bracing that may be beneficial to assist with walking. If possible, please see a physical therapist that has experience with people that have multiple sclerosis.
Here is a blog with some information on physical therapists for MS. READ MORE Good luck and keep us posted on your progress!  Here is My Question:
I HAVE TROUBLE GETTING IN AND OUT OF MY CAR. I have a Toyota 4Runner. Any suggestions? We checked with Eric Lajeunesse who is a mobility consultant at Ride-Away Corporation and he said that Adapt Solutions has a product called the XL Seat that can be installed in a 2003 – present Toyota 4Runner in the driver’s position that may help. The link to see pictures and information on this product is http://adaptsolutions.ca/products/index.php?prd=2&ftr=1. Eric said that his company has installed a few of these and they have had good feedback. Hope this helps and if you have any more questions you can call Eric (See contact information below) Eric Lajeunesse Mobility Consultant Ride-Away Corporation (603)437-4444 [email protected] I have PMS. If I work on building my muscles will I improve my mobility? Is it possible to get my motion back? I was told once I lost it, I won't get it back. Is this true?
It is certainly possible to restore motion and enhance fitness and well being even with severe disability but often to achieve success requires the use of sophisticated rehabilitation equipment such as the lokomat system, the Giger MD locomotion system and the functional electrical stimulation bicycle. This type of equipment is often available in spinal cord rehabilitation institutes and in some physical therapy departments. In San Diego, one of my colleagues, Dr Marcus Bradley has a non profit rehabilitation institute with this capability called VIP neurorehabilitation. Check out their website and try them out if you live in Southern California. Otherwise, look into rehabilitation institutes in your area. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego At the Mandell Center we certainly work on strength, but also balance and stretching. A good idea would be to find a physical therapist in the area who is an MS Specialist (MSCS). To find one, go to www.mscare.org, this is the website of The Consortium of Multiple Sclerosis Centers. Click on "contact us", fill out the form and ask to be connected with a physical therapist who is an MS Specialist in your area. It is hard to offer specifics on-line, but an evaluation and maybe some treatment by a skilled PT would give suggestions as to specific types of stretching and /or strengthening exercises would be appropriate. Lori Ann Kostich M.S. CCC-SLP Mandell Center for Multiple Sclerosis Hartford, Connecticut Here is My Question:
I had a physical therapist that tried to convince me (unsuccessfully) that canes and walkers were created for the sole purpose of luring disabled people into a false sense of security so that they would die. She was able to convince my fiance that this was true. She also convinced my fiance that if I kept using canes I must be suicidal. Subsequently my fiance hid all of my canes, making me bedridden. As a result I made it clear that she was not to return. My fiancé eventually gave me back my canes thereby allowing me to get out of bed, but she's still threatening to leave me and take my daughter. She even took her engagement ring off, because this physical therapist, that obviously got her certificate out of a crackerjack box, convinced her that if I keep insisting on using a cane or walker I must be suicidal. Is there any reading material I can supply my fiance with to show her that this woman was a crackpot? Thank you in advance. Answer: Oh my, that is quite a story. Setting the story aside, here is my advice on walking aids:
In my experience people with MS often wait too long to begin using rollator type walkers; instead, they choose to struggle with frequent falls using a cane or the walls of their home or both; they use rollator type walkers for a short period of time only or skip them and go directly to wheelchairs and scooters. I think it makes more sense to use the correct type of device so you can continue to walk safely for the longest period of time. If your problems with walking tend to fluctuate, you can use a cane on good days and a rollator walker on bad days Good luck -Rip Kinkel Question: Thank you for your explanation about Dr Gary Cutter's use of constraint induced movement therapy. As I have PPMS I found this treatment option quite exciting. I read your explanation about constraining arm movement. As my weakest area is my left leg and left foot (drop foot), could you please explain the details of how I would apply constraint induced movement therapy to my leg? Thank you for your answer as I would like to attempt this approach to assist my walking. Answer: Constraint induced movement therapy (CIMT) of the lower extremities doesn’t actually use physical restraint of a less impaired limb, as is the case with upper extremity CIMT therapy; this would not be possible since you require both limbs for ambulation. Instead an individual is trained to avoid maladaptive postures and movements with persistence of the training effect at home through behavior modification procedures, diaries and a contract with the therapist. In short you require a trained physical therapist to succeed, but to be honest many good physical therapists already use these techniques to achieve better outcomes. By the way you had me laughing when you mentioned, "Dr Gary Cutter’s study on CIMT"; Gary is a brilliant guy but he is a statistician not a rehabilitation specialist. The other authors from UAB performed the study. I’ve posted the article if you would like to take it to your physical therapist for further discussion and implementation into your rehabilitation program. Good Luck Dr Kinkel 
 My blogs are usually posted in the 'patient blog' section, but since I have a question to ask we thought placing this blog in the Q&A section for the Virtual MS Center might be more appropriate.
It's been a little while since my last blog due to yet again; medical issues. That being said, we all can relate I'm sure. As you can tell from some of my blogs, I love to travel. My last trip to the Carribbean had its moments, but the negative impact on my physical symptoms was not very positive. This leads me to my next dilemma. Some of the symptoms have not resolved and have caused additional mobility issues for me. I have been planning to take my daughter to Nashville to the country music festival for a year now. I find myself unable to do much walking due to weakness and sudden onset back pain. Mt first thoughts were to look through the blogs for advice and speak with our mobility specialist, Tom Mellor. I placed a call to Tom and within twenty four hours, I received a return call with scooter information and suggested companies that I could find in Tennessee. Although I was not able to rent a GoGo Traveler as he suggested, the company he recommended was very helpful. If my symptoms persist, I will take all of his advice to help me determine what to purchase for the future. Although Tom was extremely helpful, I'm reaching out to my fellow MS patients, bloggers, and caregivers for any tricks and/or tips you can give me about using a scooter...everything from are they safe to leave out of site, to battery function, and beyond. I'm nervous about having to travel with one and I don't want others to be inconvenienced by it. So fellow journey members, is there anything you could add to ease my mind and make this trip more enjoyable? Please write a comment below or send me an email at [email protected] --Susan A BIT ABOUT SUSAN...Susan is a registered nurse who worked in high risk obstetrics at Brigham and Women's for twenty years. She is also a certified nurse paralegal. She is currently not practicing as she is disabled because of MS. She was diagnosed 8 years ago with RRMS and has a daughter who also has MS.  I like the ease of disassembly of the Pride GoGo Traveller Elite http://www.pridemobility.com/gogo/gogoelitetraveller.asp and/or the Golden Technologies Buzzaround http://www.goldentech.com/products/buzzaround-lite/. When choosing a travel scooter also keep in mind the weight capacity of the unit and distance capability, as these vary - Tom Mellor, Assistive Technology Professional (ATP). To read more about Tom, Click Here
 The rollator (seated walker w/ hand brakes) is a wonderful product which has become increasingly popular as an ambulatory device for many people with MS. However, a rollator is NOT a wheelchair so please keep reading.
Safety and fall risk management is always critical. Therefore, before using a rollator one should consult their primary physician and physical or occupational therapist. Rollators are great…for appropriate clients. Rollators allow people with MS to walk greater distances and when they fatigue, it's a rolling seat and even has a basket to carry items from room to room or store to store. Many rollators are now lightweight and quite portable. There are also heavier ones for our bariatric clients or clients that require a more stable base. However in recent years since their increase in popularity I have seen one glaring misuse. A rollator is not a wheelchair. At my son's football games, swap meets, and graduations I have seen people pushing their loves ones in a rollator as if it was a wheelchair or transport wheelchair. There is great danger in this, as a rollator's frame does not lock and a rollator folds differently than a wheelchair. If you use a rollator in this fashion any transition in terrain is a fall risk. What is the solution? There are rollators that are especially designed for this usage. It is a "hybrid" rollator/transport wheelchair. Contact your local medical supply provider or therapist for details. Keep Fighting On, Big Love! Tom Mellor, ATP A Bit About Tom: Tom Mellor is an Assistive Technology Professional (ATP) with over 20 years of experience analyzing the needs of people with disabilities, assisting in the selection of appropriate assistive technology for the person's needs, and providing training in the use of the selected devices. |
PLEASE NOTE: This information/opinions on this site should be used as an information source only. This information does not create any patient-HCP relationship, and should not be used as a substitute for professional diagnosis and treatment. Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition.
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