Symptom Management

Declare Your Independence Using Mobility Aids

By Patricia Bobryk, MHS, PT, MSCS, ATP


 
When I meet with a new patient I always ask them, “What are your goals for coming to physical therapy?”  The majority of the time, the response I get is, “I want to keep my mobility and stay independent.”

“Mobility” is an excellent term because it encompasses all of our movements. Mobility is more than walking. It includes moving into bed, getting on and off the commode, transferring in and out of the car, climbing stairs, and a wide variety of other activities. Simply stated, mobility is any time you move your body from one place to another.

It is estimated that more than 75 percent of persons with MS will have some problem with their mobility during the course of their disease. Mobility issues can happen even early in the disease and can negatively affect your quality of life, your emotional state, and your ability to participate in activities that are important to you.

Changes in mobility can occur for a variety of reasons. Symptoms such as weakness, spasticity, fatigue, and impaired balance can alter how your movements are performed, and  the amount of energy it takes to perform them. Sometimes other issues interfere with mobility, such as pain or changes in your vision. The inability to get the proper messages from your sensory systems to your brain, as well as changes in your thinking skills, can cause problems with interpreting your environment, which can place your safety at risk.

At times, changes in your mobility have nothing to do with MS. Other conditions (like arthritis), medication side effects, or deconditioning can also influence how you move. Many times, the limitation lies in the environment itself. Do you live in a home with lots of stairs, narrow spaces, or spaces with lots of clutter? The barrier may not be a narrow space, but a large open space with surfaces that are not easily moved over, such as thick carpeting or very slick surfaces. In your community, curbs, uneven surfaces,
or accessibility of buildings might be the challenge.

Another significant issue that contributes to problems with mobility is the fear of falling. Having a previous fall, or even a near fall, can undermine your confidence and cause you to avoid certain activities. The bottom line is that mobility issues, no matter the cause, may restrict your ability to participate in work, family, social, occupational, or leisure activities.

Starting to use a mobility aid, such as a cane, walker, wheelchair, brace, shower bench, or a vehicle adaptation, can feel like a huge step. When faced with the possibility of using a mobility aid, people with MS often view it as a failure or as giving into the disease. Some people feel that once they use an assistive device they will become dependent on it. Others are concerned about how they might be viewed or that others will think less of them.

Of course, none of these things are true. It is important to examine your thoughts about mobility aids and reframe your thinking. Viewing a mobility aid as a tool that will help you maintain, or even improve, your independence can remove the negative perception. Mobility can be greatly enhanced by using an assistive device.

For example, let’s look at the common mobility problem of foot drop. Dragging your foot has a high energy expenditure and places you at risk for falling. If you are already dealing with MS fatigue, this can drastically limit the distance you can walk or how safe you are while moving. Utilizing a brace that keeps your foot from catching could positively influence your walking pattern. That is a big plus! Remember,  energy is a valuable commodity and a mobility aid can conserve that valuable resource for you.

Using a mobility aid can be very empowering. Think of arriving at your activity with good energy, feeling confident and in control of your movements and your body. Using a cane, walker, or power mobility device could do that for you. The tools you use can keep you safer, conserve your energy, and can even prevent other problems in the future.

When should you consider a mobility device? If you are experiencing frequent trips, slips, falls or near falls, now is the time to take action. An injury from a fall can substantially change your ability to participate in the activities that are important to you. If you notice that you are holding onto furniture or walls to gain some stability, your fall risk is high. Another reason to start thinking about using a mobility aid is if the tasks you are doing are  taking too much time and depleting your energy. If you are avoiding activities because they are too difficult or because you are fearful of falling, a mobility aid could be the answer to increasing your participation.

Mobility aids are not one-type-fits-all. It is essential to seek the advice of a professional that is skilled in the assessment of persons with MS, as well as knowledgeable in mobility aids. The wrong device can be costly and end up not being utilized. Whenever possible, a trial of the equipment is the best method to determine if the device will really work for you. Resist the urge to purchase something that worked for someone else. Everyone is unique and therefore their needs and solutions are unique.
 
Here are some pointers for improving your independence with the help of a mobility aid:

• Be proactive. Consider a device at the first signs of mobility problems. Don’t wait until you are avoiding activities, experiencing regular falls, or your activities become so energy-draining that you are unable to finish.
• Be open to equipment. Many times the barrier is in what we think using a mobility aid means about us and not in the actual piece of equipment.
• Seek advice from a professional that knows MS. You don’t want to end up with a closet full of equipment that isn’t right for you. Matching the most appropriate device to your needs is vital. It is extremely important that the mobility device is fitted properly to you and you know how to use and maintain it. The cost of the aid may also be a factor, so you want to make sure you get the right device the first time.

Remember, the inability to participate in activities that you enjoy or desire to
accomplish can cause frustration and may even lead to depression. Stay active and
independent with your mobility aid!
 
Types of Mobility Aids:
 
• Manual wheelchairs                                • Braces         
• Power wheelchairs                                  • Walkers      
• Scooters                                                  • Canes
• Transfer aids                                           • Hoyer lift
• Transfer disc                                            • Leg lifter
• Driving modifications                               • Bed rails
• Functional electrical stimulation              • Shoes
 
Additional Aids:
 
Bathroom Aids      
         • Elevated toilet seats          
         • Toilet safety rails
         • Tub bench
         • Long-handled shower hose
Ramps
Stair lift
Grab bars