On the Move with MS Fatigue

By Sherleen H. Mahoney, associate editor of Home Health Products

Most of us have experienced firsthand how utterly exhausted and weak we feel when we have the flu. Imagine feeling that bone-deep exhaustion every day and that?s a glimpse of what MS fatigue is like. Although it sounds debilitating, with proper treatment, including medications, physical therapy and mobility devices, MS fatigue does not have to interfere with life. Such is the life of Nancy Forbis-Stokes, a doctor of audiology, who has lived with multiple sclerosis (MS) for 10 years. Forbis-Stokes experiences MS fatigue daily but claims, "mobility devices have saved my career." She drives herself to work, where she interacts and examines patients all day long, and travels between an office, testing stations, a computer room and clinics within multiple buildings, all with the help of a scooter. As a pastime, Forbis-Stokes even uses a cart to ride her miniature horse, Otis. Forbis-Stokes is a prime example of the effectiveness of mobility equipment to treat MS fatigue.

According to the National MS Society, approximately 2.5 million people have multiple sclerosis, and yet, it is a widely misunderstood disease. Most believe MS is fatal or untreatable and that those with the disease cannot work and will ultimately end up in a wheelchair. In fact, studies show life span is not significantly affected by MS, many of the symptoms can be managed and treated, and many remain able to walk without assistance. The possibility of needing a mobility device, however, does increase the longer someone has MS.

Multiple sclerosis is a chronic, autoimmune disease that affects neurons, the cells of the brain and spinal cord that carry information, control perception and allow the brain to control the body. These neurons are protected by a layer called the myelin sheath. MS gradually destroys patches of myelin throughout the brain and spinal cord. The name "multiple sclerosis" refers to the multiple scars (or scleroses) on the myelin sheaths. Symptoms of MS include changes in sensation, visual problems, muscle weakness, and difficulties with coordination and speech. The symptoms that arise depend on the affected locations on the brain and spinal cord. MS currently does not have a cure.

According to the Paralyzed Veterans of America's "Fatigue: What You Should Know" consumer guide, fatigue is the most common symptom of multiple sclerosis. As many as 75-95 percent of all people with MS experience fatigue, and 50-60 percent say fatigue is one of their worst problems. MS fatigue differs from normal fatigue in that it causes people to tire easily and remain exhausted throughout the day. Fatigue can be related to mobility or respiratory problems, causing routine tasks and ordinary activities to require so much physical effort that they become exhausting. Primary MS fatigue is diagnosed after all other causes of fatigue are eliminated.

One of the primary treatments of MS fatigue involves mobility devices. Assessing gait, muscle strength, coordination (ataxia) and flexibility (spasticity) helps clinicians determine the best mobility device for the client. The person's type of MS, home and work environments, and family dynamic should be taken into account as well.

To lessen the effects of fatigue in MS patients, clinicians may prescribe a wide range of mobility devices based on specific needs. Often, simple foot orthotics, such as an AFO, can provide enough stabilization and balance. People that require more assistance with balance, experience muscle weakness or feel numbness in the foot — a condition called foot drop — might need a cane or a crutch. A walker offers even more stability by providing continuous support. Walkers with seats are especially beneficial for those with fatigue. Three- or four-wheel scooters help those with more severe cases of fatigue, though the client must have the strength and balance to sit upright without support. If strength and balance are a problem, a wheelchair may be more suitable. Wheelchairs are helpful for those with excessive fatigue and unsteadiness. Transfer lifts may also be incorporated to help MS clients with low mobility get in and out of a bed, a tub, an automobile or a wheelchair.

When MS fatigue causes breathing problems, devices such as a lumbar support that promote sitting upright may be prescribed. A power wheelchair might also be more effective than a manual chair.

With more than 300 clinical trials currently under way, advances in research and treatments continue to provide hope to those affected by MS.

Photo: According to the Paralyzed Veterans of America's "Fatigue: What You Should Know" consumer guide, fatigue is the most common symptom of multiple sclerosis. Download the guide from www.pva.org/cgi-bin/pvastore/products.cgi?id=1.

This article originally appeared in the April 2006 issue of HME Business.

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