Adaptive Devices

Although exercise helps maintain physical function and muscle tone, MS can cause loss of strength, spasticity, and incoordination. Many types of adaptive devices can help you deal with the problems in physical functioning caused by MS. These devices can be thought of as tools to promote safety and maximal function. The best way to determine which device is best for you is to consult a rehabilitation specialist—a physia-trist, occupational therapist, physical therapist, or rehabilitation nurse. A specialist can evaluate your needs and capabilities, and make recommendations that will accommodate fluctuations in your condition.

The following assistive devices are commonly used by people with MS.

Leg Braces

If spasticity, which is caused by involuntary muscle contractions, stiffens your knees and hips and pushes down on your feet, you may have trouble stepping high enough for your feet to clear the floor or ground. Climbing stairs or walking uphill becomes especially difficult.

A laminated polyethylene short leg brace can support the dropped foot. This device keeps the toes clear of the ground, thereby reducing the amount of energy needed to walk and lessening the risk of falls. The leg brace fits into a shoe and is not noticeable to others.

Mobility Aids

If loss of coordination becomes a problem, you can keep your gait within safe limits by using a mobility aid, such as a cane, walker, wheelchair, or electric scooter. Walking aids stabilize locomotion. Different types of aids offer varying degrees of stability, which are determined by the broadness of the walking aid.

Consult with a rehabilitation specialist to find out how much stabilization you require. This specialist can also teach you the best way to walk, go through a doorway, navigate stairs, sit down, get up from a chair, and enter and exit a car while using the aid. Remember that your use of a walking aid must be reevaluated periodically because your body undergoes changes as a result of the MS.

Canes if you have only a slight problem with stabilization, a simple cane may be sufficient. Canes are usually used on the side toward which the individual staggers (the weaker side). A quad cane—that is, a cane with four supporting points at the base—offers greater stabilization than a cane with a single tip. Quad canes come with a stable or a swivel-action base, depending on the amount of stability required. (See Figure 6.1.)

To determine the proper height of a cane, stand upright with the cane at your side. The height is correct when your elbow is at a 30-degree angle.

Walkers

Walkers are light aluminum structures with two supporting points on each side. Walkers are lifted and advanced prior to each step. Walkers offer greater stability than canes. The proper height for a walker is the same as for a cane.

Folding walkers are available and are more convenient to transport from one location to another. Occasionally, a wheeled walker or one with a seat might be prescribed. These may come with baskets to carry personal items. Please make sure that your walker, if it has wheels, is fitted with a safe braking apparatus.

some people resist using a walking aid because of its appearance. However, the price of not using an aid is further restriction of movement. Some people with MS confine themselves because they fear for their safety or feel they will appear to be intoxicated in public. If you need a walking aid, consider the many advantages it will provide. Being able to visit friends, shop, or frequent a park will broaden your horizons and deepen your connection to the world.

Wheelchairs

It is possible that a person with MS will reach a point in the progression of the disease where walking is no longer possible, despite every effort to restore or maintain it. Although almost everyone fears the prospect of using a wheelchair, those who do so find that even occasional use increases their sense of freedom and conserves their energy. Many people begin using a wheelchair part-time, when they must travel long distances or when walking becomes too tiring.

Not all wheelchairs or wheelchair users are alike. If you still have arm motion, a wheelchair can help you maintain physical fitness because so much energy is required to move the chair. However, if your upper extremities are too weak or uncoordinated to move the chair, or if you find the process too exhausting, a better option might be a motorized chair or vehicle such as a scooter. consult a rehabilitation specialist to help you find a wheelchair that is right for your physical capabilities, lifestyle, and body size. Don't buy a wheelchair from someone else because it probably won't be right for you and your insurance won't pay for it. Do not use a wheelchair that has worn or missing brakes. Do not allow anyone else to use or play with your wheelchair, because wheelchairs can and do get broken.

Your safety and comfort come first! The narrower and simpler the wheelchair, the better. A chair with removable armrests will enable you to fit the wheelchair under a desk or table, and to transfer in and out of it more easily. Footrests should swing away to allow for ease in transfer and maneuverability. The seat cushion should align the body properly to prevent skin breakdown, assist with transfers, and promote overall comfort.

For the best fit, sit in the wheelchair and check the following:

• Is there a hand's width space between the seat edge and the back of your knee?

• Is there room for two fingers between your thighs and the wheelchair sides?

• Is the backrest comfortable? The top of the rest should end at about the middle of your shoulder blades.

• Do your arms rest comfortably on the armrests?

• Are your thighs parallel to the floor?

currently, there are many options for wheeled mobility. These include motorized wheelchairs with adaptations such as "tilt-in-space" to relieve continual pressure on your buttocks; scooters for those of you who are able to walk but not long distances; and motorized units that combine features of wheelchairs and motorized tricarts. These devices are costly and may or may not be covered by insurance. Please check with your carrier and make sure all necessary paperwork is completed before you move forward in what can be a very costly purchase.

Consider getting special training to help you learn how to transfer yourself from the wheelchair to a bed, to another seat, into a shower or bathtub, and into an automobile. Transfer training will also teach you:

• What supporting surfaces are most effective.

• How to use sliding boards when your arms are weak.

• How to strengthen the muscles required for transferring.

• How to move in the shortest and most direct way.

If you have maintained your range of motion, you can often do transfer maneuvers by yourself, so that your activities are restricted only minimally.

All of these adaptive devices—leg braces, canes, walkers, and wheelchairs— promote maximum independence and minimal risk. They can boost your spirits and raise your quality of life.

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