Strategies to Help Resistant People Improve Gait

Background: People with Multiple Sclerosis (MS) often present with impaired gait, balance and motor control. Fear of falling increases their anxiety, which then contributes to fatigue and further deterioration of their gait. Why then do they often reject equipment which will improve their walking? For some it is not wanting to give into the disease or their pride. For others, they do not want people to see them using equipment because it makes them look disabled.

Objectives: 1. State two strategies to increase compliance of resistant people. 2. List three low profile items to improve foot control and gait.

Methods: A thorough evaluation of muscle strength, dynamic balance, walking measures, gait deviations and footwear is required. An honest discussion of findings and how each measure contributes to their impaired gait should follow. To further understand their deficits, a video tape of their gait is invaluable. Introduction of low-profile equipment (foot orthotics, ankle supports and trekking poles) would happen during the second session. Equipment trials should take place over all terrains and steps. Review of additional videos taken while using the devices is an effective means for people to see any functional differences the equipment provides. Talking points are more effective when direct. "Watching your videos, what looks more disabled? When you are walking slow and off balance or when you use the ankle support?” To normalize the use of an ankle support (or any device) provide rationale that "lots of people wear them due to sprains, so why would anybody look at your differently?" Also, “when you are out in public and see someone using a trekking pole, do you regard them as less than or being disabled.” Finally, “do you think you could have walked as well or as far without the device(s)?” People resistant to equipment need to know they have options. Devices can be used every day or just for longer distances, outdoors or other.

Results: Low-profile equipment can significantly improve gait for persons who have adamantly refused accessories in the past. Taking videos during device trials is essential. The more “normal” the equipment appears, the greater the likelihood of compliance. Items that significantly improve foot control and therefore gait include; Proper footwear being light weight, thinner solid sole, stiff heel counter and good arch support. Prefabricated, dense foot orthotics with deep heel cup and good arch support. Low profile neoprene ankle wraps worn in flats, dress shoes, and boots to enhance ankle stability. Ankle supports with increased malleolar control to provide neutral ankle position, to reduce extensor tone patterning in swing, to improve stability in stance and to reduce foot drop. Also, trendy trekking poles to provide a touch of balance.

Conclusions: A thorough evaluation, honest discussions, videos and trialing low profile accessories can increase success in getting people resistant to using equipment on board.