Multiple Sclerosis (MS) and Mobility: When Are Alternatives Needed?

For many people living with multiple sclerosis (MS), changes in mobility can be one of the most noticeable challenges of the condition. Walking may become more difficult, balance can become less reliable, or fatigue may make even familiar distances harder to manage.

But needing mobility support does not necessarily mean giving up independence.

A walking aid, mobility scooter or wheelchair can sometimes help someone conserve energy, move more safely and continue taking part in the activities that matter to them. The important question is not simply when should someone start using an aid? but rather: when could additional support make everyday life easier?

How can MS affect mobility?

MS affects the central nervous system, and its symptoms can vary considerably from one person to another. Mobility can therefore be affected in different ways and can change over time.

Common factors that can influence walking and movement include:

• Muscle weakness
• Balance problems
• Spasticity and muscle stiffness
• Changes in coordination
• Problems with sensation
• Visual difficulties
• Fatigue
• Reduced endurance

These symptoms do not necessarily occur together, and their impact can vary from day to day. Someone may be able to walk independently in the morning but struggle considerably after a busy day.

This variability is an important part of deciding whether additional mobility support could be useful.

Fatigue can be just as important as walking ability

When people think about mobility and MS, they often focus on whether someone can physically walk. However, fatigue can have a major impact on mobility too.

MS-related fatigue is more than ordinary tiredness. Some people experience overwhelming fatigue after relatively little activity, and other symptoms such as balance or concentration difficulties can become more noticeable when they are tired.

This can create a difficult situation: a person may technically be able to walk a certain distance, but doing so may use so much energy that they have little left for the rest of their day.

In that situation, a mobility aid can be a way of managing energy rather than simply compensating for an inability to walk. For example, someone might choose to walk short distances at home but use a wheelchair or scooter for a large shopping centre, an airport or a full day at an event.

The aim is not necessarily to walk as much as possible. It is to have enough energy for the things that matter.

When might a mobility aid be useful?

There is no single point in the course of MS when someone should start using a mobility aid. It can be worth considering additional support when walking starts to interfere with everyday activities or becomes increasingly difficult or unsafe.

Some signs may include:

• Frequently needing to stop and rest when walking
• Avoiding activities because they involve too much walking
• Increasing difficulty maintaining balance
• Experiencing repeated falls or near-falls
• Becoming significantly more fatigued after walking
• Finding longer distances increasingly difficult
• Needing to hold onto furniture or other people for support
• Feeling less confident when walking outdoors or in unfamiliar environments
• Having difficulty keeping up with everyday activities because of mobility limitations

These signs do not automatically mean that a particular mobility aid is required. They are reasons to discuss mobility with an appropriate healthcare professional.

Mobility aids can support independence

One of the common concerns around using a walking aid, scooter or wheelchair is that it might represent a loss of independence. In practice, the opposite can sometimes be true.

The MS Society notes that many people with MS use wheelchairs or scooters only for certain activities, for example because of fatigue or weakness, or to conserve energy. They may find that this gives them more freedom rather than less.

Think about someone who wants to spend an afternoon in a city centre. They may be able to walk for 20 minutes, but become exhausted afterwards. Using a mobility aid for part of the day could allow them to visit more places, stay longer and still have energy to enjoy the evening.

The mobility aid does not necessarily replace walking. It can complement it.

Which type of support is appropriate?

The right solution depends on the person’s abilities and needs.

Walking sticks and other walking aids

A walking stick or another walking aid may provide additional support with balance or confidence for some people.

It is important that the aid is appropriate for the person’s needs and used correctly. A physiotherapist or other qualified professional can help determine whether a particular walking aid is suitable and how to use it safely.

Rollators

A rollator can provide support while walking and may also allow the user to take regular seated breaks. This can be useful for someone who remains able to walk but needs additional stability or wants to manage fatigue during longer activities.

Mobility scooters

A mobility scooter can provide powered mobility while allowing someone to remain active and independent over longer distances. For some people, this can be particularly useful outdoors or when walking is possible but too physically demanding for longer periods.

Manual wheelchairs

A manual wheelchair can be used for occasional or regular mobility, depending on the person’s strength and needs. However, independently propelling a manual wheelchair requires sufficient upper-body function and can itself be physically demanding.

Powered wheelchairs

For people who cannot propel a manual wheelchair effectively or safely, a powered wheelchair can provide greater independence.

The control method then becomes an important part of the assessment. If arm and hand function are affected, alternative controls may need to be considered.

What about changing arm and hand function?

MS can affect more than walking. Some people also experience weakness, reduced coordination or changes in motor control in their arms and hands. This can become particularly relevant when someone needs to operate a powered wheelchair.

A standard joystick requires sufficient controlled hand and arm movement. If this becomes difficult, an alternative control may be considered based on the person’s remaining abilities. Depending on the individual, this could involve different types of switch, chin, head, foot or other alternative controls.

The important principle is the same as with mobility aids more generally: start with the person’s abilities and needs, then match the technology to them.

Mobility support does not have to be all or nothing

One of the most important things to remember is that mobility can be flexible. A person does not have to choose between walking and using a wheelchair. They may:

• Walk independently at home
• Use a walking aid outdoors
• Use a rollator for longer walks
• Use a mobility scooter for community activities
• Use a wheelchair when fatigue is particularly significant

The appropriate combination can also change from one day to another. This flexibility can be particularly valuable with MS, where symptoms and energy levels can fluctuate.

How should the decision be made?

Choosing a mobility aid should be an individual decision, ideally made together with the person and the professionals involved in their care. A useful assessment should consider more than walking speed or distance. Think about:

• Safety: Is the person at increased risk of falling?
• Energy: How much fatigue does walking cause, and what activities are affected afterwards?
• Function: What does the person need to be able to do independently?
• Environment: Will the mobility aid mainly be used at home, outdoors or over longer distances?
• Comfort: Can the person use the aid without causing unnecessary strain or discomfort?
• Goals: What activities does the person want to continue doing?

These questions shift the focus from “Can this person still walk?” to a more useful question:

“What support would allow this person to participate in everyday life as independently as possible?”

When walking is no longer the only goal

Maintaining mobility remains important for many people with MS, and regular physical activity can have benefits for mobility, muscle strength, mood and some MS symptoms. At the same time, there is no benefit in viewing every mobility aid as a sign of failure.

Sometimes using support allows someone to save energy, reduce the physical demands of a journey or participate in activities they would otherwise have to avoid.

Mobility should therefore be viewed more broadly than simply the ability to walk from A to B. It is about being able to get where you want to go and do what you want to do.

Alternative wheelchair control when arm function is affected

For people with MS who use a powered wheelchair but have limited arm and hand function, selecting the right control becomes an important part of maintaining independence.

Alternative controls can make use of other reliable movements, including head or foot movements, depending on the individual’s abilities.

This is also an area in which CoMoveIT works. Its wheelchair controls are designed for people with complex movement disorders, including MS, and include head and head-foot control options.

The right solution will always depend on the individual assessment.

Mobility is about more than walking

MS can change the way a person moves, but it does not have to determine where they can go or what they can participate in.

Mobility aids and alternative wheelchair controls can be valuable tools for adapting to changing abilities. Used at the right time and for the right purpose, they can help people conserve energy, improve safety and remain involved in everyday life.

The goal is not to choose between walking and mobility support. The goal is to find the right support for the way a person wants and needs to live.