Should I push myself or will I make it worse?

​Question:
Hi! My MS has progressed into Secondary-Progressive from RRMS. I have difficulty walking due to lesions on my spine. I use a walker at home and a scooter for church, shopping, etc. Sometimes I feel like I am yearning for the scooter more and more. I am blessed to be able to still use my legs, albeit it is not easy. I don't want to fall down the rabbit hole of dependence. As hard as it is, I feel I need to tough it out and use my walker for certain outings instead of the scooter. If I "push" myself, is there a benefit for using what little ability I still have in my legs, or am I aggravating my condition and advancing it? Thank you for your time!

Answer: 
You are not going to aggravate your condition if you push yourself to use your legs more. However, safety should always be your number one priority! It sounds like the scooter is the appropriate device for you to be using for your community outings, though I do understand your concern that if you don’t “use it you’ll lose it.” My advice would be to minimize your use of the scooter in your home as much as is possible, as long as you are SAFE. If you feel the need to use your scooter in the home for safety reasons, try to make a point to stand up and walk around your house 1x/hour (or whatever is reasonable for you). If you like to watch TV you can make it a goal to make some time for exercises during commercial breaks. You can do exercise from a sitting or standing level. If you are looking for some exercises the MS society has great resources. You could also seek out the assistance of a local physical therapist who can prescribe exercises specific to your needs!  I hope this help! Keep your head up and keep moving; but within safe limits of course!!!

Sarah Wargo, PT, DPT, MSCS
Mount Sinai Rehab Hospital and Mandell Center for MS 
​Hartford, CT
​
Answer:
Maintaining a standing posture and continuing to walk, if safe, are both important in people losing the ability to walk and finding themselves more and more dependent on wheelchairs or scooters. The important thing is to make sure you avoid falls and do not place unnecessary strains on your knee or ankle joints. To continue walking, people no longer able to walk on their own often resort to sling supports from a ceiling mount or even Lokomat devices at rehab centers. In the near future, robotic frames will be available to assist with walking in paraplegics. The benefits of just maintaining a standing posture through the use of a standing frame in people unable to walk are considerable. As noted in a prior blog on our site, standing frames provide the following benefits:

• Pressure ulcer prevention/ skin pressure relief

• Muscle contracture management

• Lower extremity spasticity reduction

• Improved bowel and bladder function

• Standing endurance/tolerance training

• Psychological benefits such as being eye level for interpersonal interactions

• Maintain Bone density and prevent osteoporosis

• Respiratory benefit

​
Make sure you meet with a physical therapist who is a neurological clinical specialist several times a year to make your walking is safe with your current devices and to determine if any joints require additional support.

Good luck
​
Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Professor of Clinical Neurosciences
University of California San Diego