Treatments for balance problems
Falls, dizziness and balance problems are common MS symptoms. But there are a few things you can try to manage them and improve your mobility.
Some of these you can do on your own. For others, you'll need support from a professional such as an MS nurse, physiotherapist or occupational therapist. Sometimes treating a specific symptom like 'foot drop' can help with balance and mobility.
Exercises for balance and walking
Watch the film to see Tracey give the exercises a go, and try them for yourself too. There is an audio described verison of this video.
A well-designed physiotherapy programme can help improve balance. There are different types of exercise that may be useful, including exercises specifically designed to improve balance.
The programme could also include exercises that focus on posture, and the strength and suppleness of your muscles, which could in turn benefit your balance.
There's evidence to suggest that a range of exercise therapies, including yoga, Pilates, T'ai Chi, the Feldenkrais Method and the Alexander Technique, along wtih aerobics and outdoor walking, can also help.
Aids, equipment and adaptations
Getting out and about
There are things you can do if balance issues have affected your ability to get out and about safely.
You may ﬁnd you need to pay more attention than usual to balancing when you walk and move around. You may ﬁnd it easier if you focus on walking, without doing anything else at the same time (such as talking).
Using a stick or other walking aid at times can also help. Some people ﬁnd it particularly helpful in open spaces, or in unfamiliar places. Your occupational therapist and the Disabled Living Foundation can give you further details about equipment available.
At home - simple adjustments, or perhaps some adaptations, may help if you ﬁnd it difﬁcult to move around your house safely. An occupational therapist can also help you ﬁnd suitable adjustments or adaptations.
At work - There may also be useful changes that can be made in your workplace. Employers have a legal duty to make reasonable adjustments to help you do your job.
If you have problems with foot drop you might benefit from an orthosis (a splint or brace) or Functional Electrical Stimulation (FES). A physiotherapist and a specialist in this equipment – an orthotist – can help you find what’s best for you.
Foot drop (also called "dropped foot") is when you can’t lift your foot properly when you walk. It can happen when MS has caused damage in the part of your brain or spinal cord that controls how your leg works. It also happens when MS had made a leg muscle weak or too tight. When you have dropped foot, you’re more likely to trip or fall over.
Other issues can sometimes look like foot drop. For instance, muscles might get weaker if they don’t get much use for a while.
Some of the ways to help could be the same whether it’s foot drop or another cause. For example, a physiotherapist might suggest stretches and exercises.
Othoses (splints and braces) for foot drop in MS
For drop foot, an orthotist might suggest an ankle-foot orthosis (AFO). That’s a kind of brace that goes around the foot and ankle. The right AFO will give support in some areas and be flexible in others – depending on your own specific need.
There are “off the shelf” AFOs, which suit some people. Others are customised.
An AFO isn’t always right for foot drop. It depends on exactly where the muscle weakness is that causes the foot drop. The orthotist will check this.
AFOs are available on the NHS, but some people choose to buy them privately. You should still have a proper assessment by an orthotist if you buy privately.
What is functional electronical stimulation (FES) for foot drop?
Functional Electrical Stimulation (FES) is a piece of medical kit that helps people who have foot drop. The FES machine is about the size of a pack of cards and is run by a battery.
You can wear it on your belt, in your pocket or on a strap wrapped around your knee. Two wires go from it and end in patches that have electrodes in them. These stick to the lower part of your leg, beneath your knee, where the nerve is that controls your muscle.
As you walk, these electrodes are triggered to send signals to your leg muscle. This makes it tighten for a second or two, helping you lift your foot better.
This signal doesn’t hurt but you’ll get a "pins and needles" feeling when the signal is triggered. Some types of FES devices don’t have wires. You wear them around your shin and the electrical signal is triggered by movement when you walk.
How can I try FES for my MS?
FES helps you walk faster, easier and with more confidence. If you want to try it, ask your MS nurse, GP, or neurologist. They can refer you on to your local FES service if there is one. There they’ll assess you to see if FES is right for you.
The NHS where you live decides if they’ll pay for you to have FES and in some places it can be hard to get. You can pay to have it privately but this costs between £3,000 and £5,000.
Fampridine (Fampyra) for MS
Fampridine, also known as Fampyra (and in America as Ampyra), is a drug that can help with walking. It helps about one in three people who take it. If this drug works for you it can speed up your walking by about 25%. This improvement can get less the longer you take the drug but walking is still better than if you'd never taken it. You take this drug as a tablet twice a day.
Where is fampridine (Fampyra) available for MS?
Fampridine has been available in Europe since 2011, but access to it on the NHS varies across the UK.
- In England, NICE (National Institute for Health and Care Excellence) recommends which drugs are available on the NHS. In 2022 they made a final decision that this drug wasn't cost effective. In other words, they didn't feel it gives people enough improvement in their symptoms for how much its makers wanted to charge the health service.
- In Northern Ireland too famridine isn't approved for use on the NHS
- In Wales in 2019, the All Wales Medicines Strategy Group did recommend fampridine for use on the NHS.
- In Scotland in 2020, the Scottish Medicines Consortium (SMC) approved it for use on the NHS.
Who qualifies for fampridine (Fampyra)?
Adults with MS in Scotland and Wales qualify for it if they have difficulty walking and score between 4 and 7 on the Expanded Disability Status Scale (EDSS).
We’re working to get this drug made available on the NHS to all people who could benefit from it - no matter where in the UK they live.
If your GP, MS nurse or neurologist think you need this drug they can ask the NHS locally to pay for it but this isn't usually successful. The drug is available privately for people who can afford to pay for it (from £2,500 a year, at least).
We believe if you have MS, you should get access to the right treatments at the right time, no matter where you live or what your financial situation is. We'll carry on campaigning to make fampridine available on the NHS across the UK.
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