Walking and MS - Ben Thrower, M.D. - MSFocus at Sea 2019

thank you again for for coming back and thank you Anna that was great so really if you think of questions after any of these these programs that you didn't get a chance to ask will catch us you know dinner time whenever we're happy to answer anything so we could talk a little bit about walking issues in multiple sclerosis and some of the first the first couple of slides are gonna be a little bit busy but I'll give you what the take-home point of these these the first couple of slides is why are we talking about walking issues at all well because walking issues are common in multiple sclerosis this was a survey done by a group called NAR comms and what NAR comes found when they surveyed a large number of people with MS is that only one little piece of the pie there it's about a 15% slice of the pie of people with MS said they had no walking issues whatsoever so 85% of the pie said they had some walking issues and they ranged from mild to not walking at all but the majority of people did have some walking issues with multiple sclerosis so this is an even busier slide that you can't see that I'll explain to you that says what so what does walking do to a person's ability to work and what they did is looked at both men and women with multiple sclerosis and they found that unfortunately as walking got worse the the likelihood that the person was working full-time went down so walking was strongly correlated with the ability to work full time it's interesting because when when we talk about vocational issues in MS the other two big things that affect the person's ability to walk are not as visible as walking issues and those would be cognition and fatigue we think the cognition and fatigue are actually the two things that are most likely to take someone out of the workforce but walking is clearly up there as well so walking is you know what when Anna talked about sort of this ripple effect of wellness walking has that same sort of effect and you know where we think about one of those six facets of wellness affecting the big picture walking can have this ripple effect so if you're not walking well you may get deconditioned you may become more socially isolated you may become depressed you start not going out quite as much and it just starts cycling in a downwards way fortunately we can reverse that cycle we can stop that ripple effect by addressing walking issues for people with MS so I like to think of walking issues in MS as being this sort of witch's brew of different ingredients and we're going to talk about the five major ingredients that you may have some people with MS have all of these other people mainly have one of these that's affecting their walking but we need to be aware of all of them and those are spasticity foot drop nerve fiber fatigue sensory ataxia and cerebellar dysfunction and we're going to spend some time talking about all of these and talking about what we can do to push back on that spasticity comes from a greek term os-- which means to draw or to tug and so spasticity is this sort of increase in muscle tone all humans have a balance between what our flexor muscles want what a joint to do and why our extensor muscles want that joint to do so there's normal normally this balance multiple sclerosis or any health condition that affects the central nervous system your brain or spinal cord can throw that balance off and know so now if you disconnect if you will the brain from the spinal cord with an MS lesion or spinal cord injury or a stroke you're sort of upsetting that balance and you're letting the spinal cord do more of what it wants to do so what is the spinal cord one hour one hour muscles to do think about someone who's had a stroke what do they look like in terms of their walking typically they have one arm they have the arm drawn up and the leg is stiffened out that's what the spinal cord wants the muscles to do it once your your legs to extend and it wants your arms to flex so that's what spasticity typically looks like in multiple sclerosis spasticity is sort of that chronic state of muscle tightness on top of spasticity you can have spasms so this is that wave of sudden muscle tightness so it can be a flexor spasm in the arm it could be a spasm that affects your whole body so that you're you're sort of stiffened out we see a lot of people that have extensor spasms in their legs when they try to transfer so the legs will stiffen out on them maybe when they're going from scooter to chair or going from Chum from chair to sitting up most people with spasticity have really brisk deep tendon reflexes when you see your your health care provider and they tap on your knee in your ear sir your need jerks we grade those reflexes from 0 to 4 0 means we tap on your knee you don't move at all 1 means it's a little bit there most people live in a 2 that's a normal human deep tendon reflex if we tap on your knee and it really goes out aggressively that's that's a 3 or a 4 for his clonise it means it's just the the joint is bouncing some of you probably notice if you get your leg in just the right position or wrong position that your leg starts bouncing up and down that's clonus that's a deep tendon reflex that's firing over and over again so that's an exaggerated reflex with medical students if we like them we warn them that most of our folks with MS have what we call get back reflexes that means that you tap on their knee and you better get back if they're if they're are smart alecky know-it-all medical student we don't warn them about the get back reflexes so we talked about some of the the signs of spasticity these the brisk deep tendon reflexes spasms clonus again is that bouncy reflex spasms can be pain painful frequently they're painful for people and so the all of these things add up to impair your ability to function that's really what it's all about is your ability to do what you want to do and specificity can clearly affect your ability to function on a daily basis so we talked about spasticity as if it would always be a bad thing and Ian may cover some of this in and the the more hands-on talk about walking issues but spasticity is not always bad let's imagine that you've got weakness in your legs but you also have a little bit of extensor spasticity your legs want to stiffen out maybe you use that extensor tone to help with transfers or with walking so one of the things that I like to do early on in people with MS is get them to someone like Ian or Anna and the physical therapists say how much of the spasticity is bad and how much of his is good how aggressive should we be in managing this because we always on our end we always have more drugs we can throw at you and sometimes we don't want to go to that toolbox right off the bat we would rather do things that don't involve more medications so the when we think about managing spasticity we talk about a step ladder approach which we want to address the easiest things first and one of the easiest things to do and one of the most important things to do is to remove noxious stimuli we'll talk about some of the what is a noxious stimulus spasticity and spasms tend to be very responsive to what's going on in your life if something's not right you're overheated you have a urinary tract infection you're stressed you're sleep-deprived these things can set off spasticity and we want to try to address those and if we can remove some of those things use that as our first line of treatment next line of treatment is rehabilitation therapy getting you in with a physical therapy making sure that you've got a good range of motion or stretching program then we bring out the medications and then sort of it the the top would be something like intrathecal baclofen which we'll talk a little bit more about so these are some of those noxious stimuli things that may irritate even something like a shoe or a sock that's irritating to you can make your muscle tone more if you have skin breakdown that's going to increase spasticity though I would say in our clinic the most common thing that we see if someone calls in and says you know my spasms have just really kicked up horribly in the past 24 hours the thing that I'm always on the lookout for is a urinary tract affection for many people with MS their symptoms of a bladder infection aren't gonna be neurological they're gonna be neurological they're gonna be increases in your spasticity more weakness maybe more fatigue so anytime you're thrown off your game always kind of step back and look at bladder function so rehabilitation therapy stretching weight-bearing Botox injections if you have them just a limited area of increased muscle tone maybe we can have someone do a Botox injection we don't want to do Botox injections into muscles that you need for function because what Botox is doing is temporarily paralyzing that muscle so we don't want to sacrifice muscles even for a short period of time that you need to function on a daily basis cereal castings what if you've got a contracture you've had spasticity and an arm or a leg for so long that the joints are actually tight now well that's gonna be a tough thing to work work with in terms of medications or just stretching so sometimes what we'll do is have the person get cereal casting put on a cast that's just going to stretch that that joint a little bit leave it on for a short period of time do another cast and just slowly over over weeks move that joint so that it has better range of motion and then we get to medications so our two old standby medications would probably be baclofen on the top and then the fourth one Thai sanity and these are our old go-to medications benzodiazepines these are your valium ativan type drugs can be very effective for managing spasms and spasticity but we have to also be aware that can be sedating and they also have some addiction potential so not always our first thing that we would we reach for how many of you are familiar with the third drug on there dantrolene or Dan trium so dantrolene is interesting it's if you went to our spinal cord injury side of Shepherd Center they use dantrolene all the time to treat spasticity we hardly ever use it most people with MS have never heard of it for some reasons I can't explain it doesn't seem to work very well in our population said the really works okay and people with spinal cord trauma but I've just never seen it do much for personal ms but it is in the toolbox keppra or levitt racetam is a seizure medicine that we sometimes you just treat spasms and then i cannabinoids is actually misspelled that second i should be an a kent cannabinoids we're gonna talk about in my second lecture so these are your quote-unquote medical marijuana and this is this is something that we do look at from managing spasms and spasticity right now the the only real fda approved version we have is the marinol or dronabinol dronabinol is FDA approved for nausea and chemotherapy patients is approved in people with HIV to stimulate their appetite it is synthetic THC so if we can use it sometimes to treat spasticity but we'll talk about some of the other options on there in great lengths in the in the next lecture so what if all these things have been tried and just aren't working out what if we could put the baclofen into the spinal fluid itself so this is intrathecal baclofen pumps so when we take baclofen by mouth it goes into our GI tract it goes into the bloodstream it goes to the liver a fair amount of it gets metabolized through the liver and then some of it actually goes into the brain itself that's not where we want baclofen working we want baclofen working at the spinal cord level baclofen in the brain is where you get your drowsiness from back home is baclofen and the spinal cord level is where you get your good anti spasticity effect from the drug so what if we could just bathe the spinal cord through the spinal fluid in concentrated liquid baclofen in theory you would get all the good without any of the of the bad it is a surgical procedure it's not something that we go to as a first first option this pump here that you've seen the picture is about the size of a hockey puck and it's just inserted surgically under the skin on your side and then has tubing that runs under the skin and delivers that medic that concentrated liquid baclofen into this they into the spinal fluid so shifting to our next one so that was the first form of first thing that can affect walking in people with MS is spasticity the next one is foot drop this is one of my favorite things to talk about because surprisingly you would think it would be pretty obvious that when people have a foot drop but sometimes it's it's under recognized and it's under treated by the medical community so if you had to pick the two weakest muscles in the legs and a person with MS it's gonna be your ankle dorsiflex or your ability to get your toes up off the ground and it's gonna be your hip flexors your ability to bring your knee up off the ground so if a person only had weakness in their ankle dorsiflex or they would do something called a steppin gate they would bring their knee up higher so that their toes don't drag the ground and if you go to most inner cities and you drive downtown you'll see someone doing the Stephan's gait is if sometimes people that have alcohol issues and they've damaged their peroneal nerve on the outside of their knee so they're walking with this very high step gait so that they don't drag their toes the problem for people with MS is if your ankle dorsiflex or weak your ability to get your toes up there's a good chance that your hip flexors are weak so most people with MS cannot do a step educate what they do instead is something called circumduction they swing the leg out and around so they don't drag their toes and this is where the significant others the care partners for the person with MS are a great help will say you know when you're watching your spouse your brother and your sister your mom your dad when you watch them walk when they get tired what do they look like in this eye well you know it's weird they go from this kind of to and fro motion to kind of swinging that leg out and about a little bit so it can be subtle but it is there what's the problem with circumduction well now you're using muscles to walk that you weren't designed to use to walk with so it puts stress on your knee and your hip and your lower back and it fatigues you very quickly so you go from being a little tired with your walking to really hitting the wall and not being able to walk walk well traditionally if we send you to a physical therapist with this sort of problem they're gonna prescribe an ankle foot orthotic and some people don't like their ankle foot orthotics there are great ones out there I will say a lot of ankle foot sit in the closet we know for a fact so we're on to you guys you wear your ankle foot orthotics when you come to see us and otherwise they sit in your closet you're just trying to make us happy don't try to make us happy do what's right for yourself and so while the ankle foot orthotics can be great for some people there are other devices out there so these are some of the lighter weight sort of variations of ankle foot orthotics called toe off devices there there are actually two over-the-counter devices that I'm going to talk just briefly about there's something called the dorsi strap so if you just have a little bit of ankle of weakness a little bit of foot drop and maybe it only acts up when you really walk a long ways maybe something as simple as this dorsi strap device would do the trick for you maybe you have a trip to Disney World planned and you know if you walk a long ways that foots gonna drag a little bit this is a simple $49 device it goes behind your heel and it laces up into your shoe it doesn't give you any lateral support but it will have to get your toes up off the ground very inexpensive very comfortable kind of another over-the-counter device that's a little more sturdy as this device from a company called Sabo this the the Sabo device is a pretty sturdy collar that goes around your ankle and it has those little cables that come out and clip onto your shoe you'll notice on the front of the device there's a little knob that's a tensioned adjuster so you can crank that device in as much as you want these things are sturdy they're about 149 dollars but it will last you forever it gives you a little bit more lateral support it will get your foot up off the ground one of the things that we hear from from individuals when they think about the ankle foot orthotic one of the one of the reasons that people don't like to wear them is because they don't want people to see it and so I would say these two devices are a little less obvious and can be easily worn under under clothing so then we get into what we would call functional electrical stimulation what if instead of bracing your leg what if we could in effect rewire your leg and make the nerve work again if you can't get the signal from your brain to the foot to make your foot come up what if we could just bypass the brain to a device and so there are two that we that we think of commonly there's the walk aid device this is a knee brace that goes around your knee you can see the the person has one on and that the picture the cartoon and it's going to stimulate the peroneal nerve and make your foot come up so what don't we like about the walk aid device the the problem with the walking device for people with multiple sclerosis is that it fires your foot it makes your foot work again based upon acceleration and tilt it has the device has an accelerometer and a tilt ometer built into it and the physical therapists have to set those parameters at a certain level they have to say well based upon what I'm seeing here in the clinic I'm gonna have that device fire when you do X the problem for people with MS is you don't do X all throughout the day in the morning you do X at lunchtime you do Y and then at an athlete up and you do Z and so people with MS have progression of symptoms sometimes throughout the day as they get tired or and the walk aid isn't necessarily able to adapt to that it's set from one parameter it may be better suited for someone with a stroke or spinal cord injury where that level of weakness is fairly constant throughout the day so this is the other device the the bonus device and there are two versions of this this was our original version called the bonus L 300 and you know if you can see down on her her right shoe she's got a little clip so you've got the nerve stimulator on her knee and then down on her shoe she has a radio telemetry device that radio telemetry device is sensing when her foot has to fire it's sending the signal back up to her knee and saying okay make the foot come up she also has a cuff on top of her her a peroneal nerve stimulator that can make her knee flexors work so she's hitting actually two of the muscles in the legs to make her foot work again this is the new version the bionis L 300 and what they've gotten rid of with it with the upgrade is there's no longer the radio telemetry device on your shoe so now built into this there's a 3d and Ian you may understand the technology better it reads your environment basically and so it can adapt as your weakness changes throughout the day but you don't have to have the the foot sensor downstream you could wear this with no shoes on one of the most important things that in my opinion with these devices is I think every one with a foot drop probably should be given an opportunity to try one of these out they work wonderfully for some people but not for everybody sometimes the person has too much spasticity in their legs and you'd the device just can't overcome that spasticity some people find the nerve stimulus just to be uncomfortable and they don't like how that feels throughout the day but I think these can be great great things for helping with with foot drop this was a little case study we did an individual patient a few years ago this was an individual who's walking with the walker and she she does her time ten meter walk without her bi'ness device on and it took her almost a minute and a half to go ten meters without the bionis unit on she puts the bi'ness unit on and she cuts that in half more than in half she's 40 seconds now so she doubled her walking speed with with one of these devices on so they can make a big difference for individuals with MS so nerve fiber fatiguing this is going to tie in to us and what some of you folks were talking about with your heat sensitivity so so the way that nerve fibers should work in your brain and spinal cord is on the top part of that slide so that's a sort of a schematic showing nerve fibers that have myelin on them and you'll notice they kind of look like little sausage links on end the gap between the sausages is called a node of ranvier it's an it's a naturally non myelinated area and normally what happens when you want to get electrical information from your brain to somewhere else in your body or from somewhere in your body back to the brain the electrical information jumps from gap to gap to gap it's a very fast very efficient way to get information up and down the central nervous system it's called saltatory conduction so now ms comes along and it messes up that really good system ms is going to come along and strip that that insulation away from that nerve fiber and it's gonna leave a naked gap where there's no insulation that electrical information can't jump that gap now so what it has to do is Rican duct itself in little baby steps across that naked nerve fiber it's Plan B it works it doesn't work as well as the original equipment and that naked nerve fiber will always potentially be the weak link in the electrical conduction chain so while it may work if everything's perfect you're sitting here in a nice cool room it's early in the morning you have hopefully had a good night's sleep if we took some of you out now instead of okay let's go out and do 20 laps around the track and it's 90 degrees outside well then that nerve fiber has something called conduction block it just shuts down one of the important things to know with conduction blocks so if you exercise or get overheated and you have a symptom act up it's an electrical phenomenon you're not causing damage you're not hurting anything once you cool off rest relax you're gonna recharge your battery and hopefully be good to go that time that it takes to recharge your battery varies from person to person and some people they can recharge their body and battery in 30 minutes and other people they're gonna have to get a good night's sleep and really cool off before that battery is recharged so how do we treat that cooling options so the cooling supplies that the EMS focus folks help people with can be just a lifesaver for helping you get out and not be a prisoner in your own home and having to stay right next to the air conditioner we have some people that like doing sort of improvised cooling vest if you will how many of you familiar with camelbaks - so Camelback is is basically a canteen if you will that was developed for the military it's like a backpack and it's got a bladder in the back and they come in different sizes you can do a one gallon or a two gallon and what what I have individuals do is just take the lid that's got a little screw in lid take the lid off of that and just cram that thing full of ice the opening is pretty big put ice in it put your water in there it's got a little straw that comes around the top and it clips on to the strap here so you've got your your built-in cooling you've got your cooling unit basically over your back and you get these on Amazon for 30 40 bucks they even have backpacks now that have camel backs built into them so you can have your backpack with the the the camel back already in it but those are can be a nice inexpensive improvised cooling vest keep drinking supercooled liquids throughout the day so making things that have the consistency of like a slushy or a Slurpee will really help you drink your drop your core body temperature and help you tolerate heat a little bit better doesn't have to be water there are other things that have that consistency pina coladas margaritas just just saying you're on a cruise ship yeah so the next one we're going to talk about is compounded for AP or for amino pyridine how many familiarity are in pyrrha the FDA approved third option there we had four amino pyridine these drugs do these molecules do exactly the same thing these are both potassium channel modulators when you think about that naked nerve fiber the way nerve fibers conduct electrical information is through sodium potassium and calcium channels and we can affect how nerve fibres work by modulating how those those channels work and so for amino pyridine is a molecule that was made in mom-and-pop pharmacies it was compounded going back to the 1960s so this stuff's been around forever and we never thought of form you know pyridine as something that just helped walking it can we thought of for me--not pyridine is something that helped with exertional or heat related symptoms so if you said that your vision got dim if you got overheated because you've had a prior optic neuritis we would try out for immuno pyridine to see if it would help with that if you said that your legs got weaker with exertion or heat we would try out form you know pyridine well then sometime about 20 years ago pharmaceutical company accord of form circle said that's a really cool molecule we should try to patent that and so they started doing studies and to see if they could get FDA approval for it well they had to study something very specific you can't just say I'm gonna help heat sensitivity and observe you had to pick something so they picked walking and so impera got FDA approval as the walking drug back in 2010 what they showed in their studies is they're about 40% of people on Imperial walked faster while they were on it and Paragons really the same molecule as four amino pyridine just a recently Imperial went generic so there is a generic form out there what's the downside with form you know pyridine or in Pyrrha probably the biggest downside is they don't work for everybody they work again for about forty percent of people and you'll know in about four weeks if you're going to be in that good forty percent group or here in the group who just doesn't get anything from it we will not use these drugs if there's any suspicion that you could be at risk for seizures so there's a fine line between improving electrical conduction and the brain in helping and doing that a little bit too much in actually provoking seizures in the wrong person sensory ataxia so eight axia means you walk like you've had a drink too many sensory means you do it because you can't feel where your feet are at so what ms can do is it affects proprioception your ability to sense position so i don't know if you've seen the t-shirts i know several of our folks we work with have them that I'm not drunk I have MS shirts I've I've seen those for a while I had a spouse come in the other day and they had the opposite shirt on they said I don't have MS I'm drunk Oh that's a brave man and so sensory ataxia again you literally walk like you've had a drink too many and so what does that look like people with sensory ataxia tend to walk with their feet further apart you're less likely to fall if you have a wider base so putting your feet further apart they tend to use what we call improvised assistive devices they use their spouse somebody next to them they use the walls they know where the furniture is that they may use service animals I'm gonna have a big big dog that they lean on and then we have a formal assistive devices so canes and walkers unfortunately people are at risk for falling when they have sensory ataxia so if you can't feel where your feet are at and you're at risk for falling what is your brain gonna use as a backup so that hopefully you don't fall we want to take a guess your eyesight so your vision primarily so so if you can see the horizon and say okay I'm tilting a little bit I better not do that that's a backup mechanism what's the problem with that is people take that away from themselves and don't even think about it if you're walking and you're trying to use the horizon as soon as you look at the person next to you and start having a conversation is just like closing your eyes and trying to walk standing in the shower with your eyes closed - you know wash your hair there's nothing soft to land on in the shower if you if you go down yep you go backwards and if we see a lot of injuries the other problem that we see is when people get up to go to the restroom in the middle of the night they don't have a nightlight on and so you always want to have some kind of lighting a lot of people compensate at home they know where the furniture is at so they get up it's poorly lit but they know okay bad dresser door knob boom what happens when you come on a cruise though now that everything is in a different place and you start to reach and bam so just make sure you have lighting on at night so that you're not putting yourself at a disadvantage so we're gonna shift now to cerebellar dysfunction so the cerebellum is the primitive back part of our brain that it doesn't control things like sensation and strength it really controls how much we move so if you have a cerebellar issue you may still be able to move your arm out but let's say you want to reach out and touch something what happens with cerebellar dysfunction yeah you're gonna be all over the place so we see individuals with cerebellar dysfunction who have normal strength and normal sensation but they still have significant trouble walking because they're just all over the place so you can have several or dysfunction that affects your arms or legs you can have cerebellar dysfunction that affects your trunk as well so dysmetria or tremor is one of the symptoms that we see with cerebellar dysfunction a taxi again walking like you've had a drink too many cerebellar dysfunction can affect speech so sometimes what we see in people with cerebellar dysfunction is that rather than having the normal highs and lows with speech their speech has kind of a either a flat tone or the highs and lows are in the wrong place so I would say cerebellar dysfunction can be one of the tougher things for us to treat we do get therapists involved very fairly early on our medications are not great for cerebellar dysfunction we try out a drug called primidone or my saline primidone is an old seizure drug it helps a little bit with tremor of the problem is it can be really really sedating for a lot of people deep brain stimulation so if if the if you're having a hard time controlling how much you move in an arm or a leg a neurosurgeon can tap into the deep part of the brain called the thalamus and actually try to override your tremor this is an interesting surgery if you ever watch a video of it it's a surgery that's done awake so the person is completely awake during the surgery they numb everything at the scalp so nothing hurts but the reason they want to do it while you're awake is they want to know when they've got the electrode in the right place so if you were trying to give someone better function in the right arm you're gonna do the left side of their brain and you can have them doing things with the right arm trying to use the the extremity and showing that when you've got that electrode just in the right place that their tremor stops we have a couple of individuals who've had this done on both sides of the brain and it can make a big difference in the right end so I wanted to wrap up and just talk about some other options that are out there for just working with with gait issues with people with MS we'll talk a little bit about robotic aides talk a little bit about newer rehab approaches and newer medications as well so we think about robotic aides these are basically things like exoskeletons what if you have enough weakness from MS or spinal cord trauma that you just cannot get out of a scooter or chair everyone there's several companies out there like the Cyberdyne Hal system where the you're just gonna say I'm gonna give you a device externally that's gonna make you make you able to walk again some of the challenges with some of these devices is they have to have a motor that you wear usually as a backpack and some of those original motor systems have been pretty heavy some of the original units the the backpack weight forty pounds so if you are a smaller person or you had weakness or god forbid you fell down you're like a turtle then you're kind of stuck this is another one the key go exoskeleton and then one that we're researching at Shepherd Center is the Indigo exoskeleton and this is actually one of our Shepherd employees young man had a motorcycle accident one of the areas that we're very interested in researching in terms of another another rehab option is FES bikes functional electrical stimulation bikes and this the idea here and you know you're gonna cover some of this also okay I won't touch on as much the idea here is if we can put you on an exercise bike and have electrodes that would override your weakness and let you keep going or maybe have the motor on the bike keep moving your legs even when you're not able to get that signal from brain to spinal cord will you get benefit from that and what some of the studies that have shown is that yes people do they show better endurance and better strength by working with something like the FES bike with MS one of the the slides I didn't put in here but it speaks to your work is cowgirl with horseback riding so for sensory ataxia one of the the best things that we can do to work with sensory ataxia is improve your core strength and one of the novel ways of potentially improving your core strength is through hippotherapy Hippo therapies physical therapy on horseback and this was originally designed for children with cerebral palsy but then it has branched out into adults with stroke multiple sclerosis spinal cord injury years ago Shepherd Center had a program called horses for Heroes so the veterans who had spinal cord injuries through you know DD explosions in the Middle East once they finished with their inpatient rehab they would go out and work at chastain Horse Park in Atlanta with hippotherapy if you think about it if you're on horseback you've got to use all of those core muscles to keep yourself upright and when that horse is moving your pelvis is moving just like you're walking if you go to a certified hypnotherapist Hippo therapists are physical therapists who have done the extra training to do this modality and if it's a certified hippotherapy facility run by physical therapists it can be you can get a prescription and have a cover by your insurance and insurance will always limit on how much your physical therapy you can do and a lot of people then if they want to keep up with it they'll just pay out-of-pocket kind of the next level down for that would be therapeutic riding and the therapeutic riding is usually these are not run by physical therapists but it can still be really beneficial you're getting a lot of the same benefits you just need to look at what the facility and that their resources look like if you're say using power mobility you may need some a lot of assistance to get on horseback and if I know if you go to somewhere like Chastain Park worth of physical therapists are running I've never seen anyone that the chassis ain't people cannot get on horseback therapy righty and they usually they're a little bit more limited in who they can get on horseback yeah and that this we're finishing up now so one of the things that is on the horizon is the idea of surgically implanted ions we talked about that biomass device to help with your foot drop so using an electrical stimulation externally to make the nerve work what if we could implant the the sort of a nerve stimulator surgically over the motor point of that nerve and then give you basically like something that would look like a pager a CPU that would send the motor program that you could do one of these surgically implanted by on over your hip flexors over your knee flexors over your ankle dorsiflex arse and you could say okay I'm walking and this CPU would have the knowledge to say okay fire the muscles in this order now fire the other leg there are several research groups working on this one of the reasons we really need this is that the one muscle that we've never come up with a way of externally stimulating are the hip flexors we do not have any BIOS type unit they can work on the hip flexors because the amount of the electrical stimulus that you would need externally would probably be really unpleasant if you did that to someone and then lastly some research that we're finishing up Shep 'red is sort of a new use of an old drug amantadine amantadine is an old old anti-influenza drug back in the 1960s and 70s though some thought that that ms might be linked to influenza it's not when they tried out the amantadine to treat multiple sclerosis what they found is that about 40% of people got a nice energy boost with it so the you know the most common type of fatigue that we see in ms called lassitude the non exertional non heat related someone's just unplugged your energy supply type of fatigue some people get a nice energy boost when they take a man to Dean researchers in the past few years went back to the amantadine they said you know when we look at the short acting form of this drug and the way people with MS are using it they're probably not getting the maximum benefit from the drug and we think if we reformulate this into an extended-release form and change the way people take it that we might do more than just bump energy levels that we would actually improve walking and people with MS when when they came to us with this idea years ago and we signed on to the initial stud the pilot trial I really didn't think that this would work we've used a Manta Dean forever and I just think that it wouldn't help someone's walking and we were wrong in the pilot trial it did improve walking now we're doing a much larger study to see if this carries over into a bigger group of people with MS so hopefully we'll have another tool in the toolbox soon to improve walking for people with MS thank you very much for being here I will see here this afternoon at 2 o'clock go have a great lunch

Channel: Multiple Sclerosis Foundation

Views: 21,454

Keywords: walking and ms, ms, multiple sclerosis foundation, msfocus, msfocus at sea, walking

Id: clV-w_CJ054

Length: 39min 9sec (2349 seconds)

Published: Fri Jun 28 2019