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Multiple Sclerosis

What are the differences between MS and ALS?

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Multiple sclerosis and amyotrophic lateral sclerosis are both chronic disorders affecting the central nervous system, and affecting the ability of a person to conduct their everyday tasks.

Both conditions can have similar effects and symptoms but treatment and outlook are different.

This article addresses the similarities and distinctions between multiple sclerosis (MS) and lateral amyotrophic sclerosis (ALS).

What is MS?

Most people with MS will have a normal lifespan, and symptoms may not be present all the time.
Most people with MS will have a normal lifespan, and symptoms may not be present all the time.

In MS, the body’s immune system mistakenly attacks myelin, the substance in the central nervous system ( CNS) which protects the nerves. That results in myelin sheath damage and scarring.

That can lead to nerve impulses being interrupted or distorted as they pass between the brain and the spinal cord. These adjustments can lead to a vast array of symptoms.

These signs can have varying impacts. A individual may experience a worsening of symptoms for a while during remitting-relapsing MS (RRMS), then make a partial or complete recovery.

However, the symptoms tend to return.

In progressive forms of MS, the symptoms do not go away but gradually worsen.

Symptoms may be mild, extreme or moderate. Some people will finally lose their walking and talking skills, but that’s uncommon. MS normally does not impact life expectancy.

What is ALS?

ALS is a chronic neurologic disorder, or Lou Gehrig ‘s disease. It prevents proper functioning of the nerves which control muscle movement.

In time, nerve damage contributes to muscle weakness and finally to paralysis.

ALS impacts breathing in its late stages, and that can make it life-threatening.

Differences between MS and ALS

Both MS and ALS are CNS-affecting neurodegenerative diseases. According to the National Multiple Sclerosis Society, MS is more common , affecting up to 1 million adults in the United States.

The National Institute of Neurological Disorders and Stroke (NINDS) estimates it affects about 250,000–350,000 individuals, although they say the exact figure is hard to tell.

According to the NINDS, approximately 14,000–15,000 U.S. individuals may be living with ALS.

Symptoms which overlap include muscle weakness and paralysis. There is no remedy for either disorder at this time, but the effects of both can be treated. In the case of MS, there are now therapies which can avoid flares and delay the disease progression.

MS and ALS vary in several significant respects, however.

Who do MS and ALS affect?

ALS is more popular in men by 20 percent. It most likely starts at age 55–75, but it can occur at any age.

MS is more common in women and usually occurs at 20–50 years of age, but can occur at any age as well.

Other basic differences include:

  • ALS often causes paralysis. This is rare with MS.
  • ALS mainly affects physical functions, while MS can lead to problems with memory and thinking.
  • ALS is not an autoimmune disease, but MS probably results from a faulty immune reaction.

The following table summarizes some of the other differences between the two conditions.

MSALS
Autoimmune diseaseYesNo
Most affected genderFemaleMale
Age range20–5040–70
Physical symptomsYesYes
Mental symptomsYesNo
May lead to deathNoYes
Has a cureNoNo

Causes

MS and ALS seem to have different causes which we will discuss in the following sections in more detail.

MS

Experts aren’t sure exactly why MS is growing. Some people may have genetic factors which increase the risk of it occurring when there are also certain environmental factors.

The following may play a role:

  • Immunological factors: There may be a link with other autoimmune conditions.
  • Environmental triggers: Smoking, having low vitamin D levels, and living in a colder climate are common factors.
  • Infectious diseases: Certain viral infections may play a role.
  • Genetic factors: These might increase the risk.

ALS

Most ALS cases do not have a specific cause, although genetic factors do seem to play a role. Experts agree that about 60 percent of people with ALS have a genetic trait that results in symptom growth.

Veterans tend to be more likely to develop ALS, indicating that environmental factors may also play a role.

ALS does not appear to require an unusual development in the immune system.

Symptoms

MS and ALS symptoms can be similar but there are some major variations to remember.

MS

MS symptoms vary widely from person to person. They can also be unpredictable and can change over time. One person may live with mild symptoms for many years, while another may experience a loss of mobility.

Symptoms of MS include:

  • fatigue and weakness
  • difficulties with walking and balance
  • vision problems
  • pain, numbness, or tingling
  • bladder or bowel problems
  • changes in thinking and memory
  • pain
  • depression
  • sexual problems
  • dizziness and vertigo
  • itching

Symptoms may come and go in RRMS, the most frequent form of MS, during cycles of flare and recovery.

ALS

ALS symptoms can also vary widely. With ALS the muscles steadily and painlessly weaken. However, once ALS starts, it can take as little as 3 years to affect a person’s life significantly.

Symptoms of ALS may start in muscles controlling speech and swallowing. Symptoms may start with some people’s hands , arms , legs, or feet. But gradual muscle weakening and paralysis affect almost all with ALS over time.

Other symptoms of ALS include:

  • tripping when walking
  • abnormal fatigue of the arms, legs, or both
  • slurred speech
  • uncontrollable laughing or crying
  • dropping objects
  • muscle cramps and twitches

As ALS progresses, it can affect the muscles in the respiratory system , making breathing difficult. A individual may need to use a ventilator, for that purpose.

Experiencing remission is uncommon in a person with ALS.

Treatment

Currently there is no cure for either MS or ALS but medication is available to delay development and symptom control.

MS treatment options

Physical therapy can treat both ALS and MS.

For MS, the American Academy of Neurology recommendations suggest beginning from the early stages using a disease-modifying treatment. The medications are intended for normal use, whether there are signs or not.

These can reduce the risk of flares and may delay the condition ‘s progression. A individual should talk to his doctor about the best medicine for his or her situation.

Other treatment options may assist in managing flares and treating symptoms.

They include:

  • Corticosteroid injections: These reduce nerve inflammation, can reduce the impact of a flare, and help manage severe symptoms. A doctor will give these only when necessary.
  • Plasma exchange: This involves taking blood from the person’s body, removing certain substances from it, and returning it to the body. This is suitable for people with severe symptoms and when other medications do not help.
  • Lifestyle remedies: Exercising when possible, avoiding smoking, eating a healthful diet, and taking doctor-recommended supplements may help.
  • Physical therapy: Various types of therapy can help a person maintain strength and flexibility and find new ways to carry out tasks as their abilities change.
  • Other treatments: A doctor can recommend a variety of treatments for symptoms such as depression, constipation, pain, and itching, among others.

ALS treatment options

There are many forms of treatment available to delay the progression of the disease and to help a person control their symptoms. An individual may also wish to try various forms of therapy or make some changes in lifestyle:

  • Riluzole and Edaravone: Riluzole (Rilutek or Tiglutik) is a drug that may reduce damage to the muscles and nerves, but it cannot reverse the damage. Edaravone (Radicava) may slow the progression of ALS.
  • Other medications: Medications are available that can help reduce symptoms such as fatigue and pain, muscle cramps, spasms and involuntary displays of emotion, and excess saliva and phlegm.
  • Condition management strategies: Trying physical and speech therapies, assistive technology, feeding tubes, ventilators, and occupational therapy can help improve quality of life. Counseling may help with depression and sleep issues.

Outlook

MS and ALS have common symptoms but there are also major variations. The outlook is one big difference between the circumstances.

Both are disorders that are degenerative and can develop over time.

But a person with MS can live with only mild symptoms for several years. A person with MS will have roughly the same life expectancy as an individual without MS, according to the NINDS.

ALS, on the other hand, is more likely to develop quickly and become life-threatening because of its resulting respiratory failure. The life expectancy of a person with ALS is 2–5 years after diagnosis according to the ALS Association.

However, 50 percent of people with ALS will live after diagnosis for at least another 3 years, while 5 percent will live longer or more for 20 years.

Many treatment options and lifestyle changes can help improve a person’s quality of life with either MS or ALS, and ongoing studies may help improve future outlook.

Some scientists believe regenerative treatments such as stem cell therapy will reverse or repair neurological damage in time. That may mean a remedy for conditions like MS and ALS.

Immune System / Vaccines

Concussion in adolescents linked to an increased chance of developing MS later in life

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A recent study finds that people who get a concussion as teenagers are more likely to acquire multiple sclerosis later in life.

A concussion is a type of traumatic brain injury (TBI) that is caused by a quick impact or shock to the head and can impair brain function.

Loss of consciousness, dizziness, impaired balance and coordination, changes in behavior and mood, memory issues, and confusion are all signs and symptoms of a concussion. Symptoms usually occur within a few days of a head injury, although they might take up to a week.

While concussion symptoms are generally temporary, research has recently revealed that head trauma can have long-term consequences for brain health.

brain concussion

Researchers have now discovered a relationship between adolescent concussion and the chance of developing multiple sclerosis (MS) later in life.

Prof. Scott Montgomery of Sweden’s Oerebro University and colleagues published their findings in the Annals of Neurology recently.

MS is a neurological disease that affects around 2.3 million people worldwide.

An aberrant immune reaction is thought to be the cause of the condition, in which the immune system assaults and destroys myelin, a fatty material that protects nerve fibers in the central nervous system.

Prof. Montgomery and colleagues identified 7,292 MS patients using data from the national Swedish Patient and Multiple Sclerosis registries. All of the participants were born between 1964 and 2012, and MS diagnoses were made between 1964 and 2012.

Each MS patient was matched with ten people who did not have MS on the basis of sex, year of birth, age at MS diagnosis, and location of residence. In all, 80,212 people took part in the survey.

The researchers also looked for any concussion diagnoses among the subjects during childhood (between the ages of birth and ten years) and adolescence using data from the Swedish Patient Register (between the ages of 11 and 20 years).

MS risk increased more than twofold

The researchers discovered no link between childhood concussions and the chance of developing MS later in life.

Participants who had one concussion in adolescence were 22 percent more likely to get an MS diagnosis later in life, whereas those who had more than one concussion were more than twice more likely to have MS later in life.

According to previous study, head trauma can trigger an aberrant immune response that harms the brain. This procedure, according to the authors, might explain their findings.

“Head trauma in adolescence, particularly if repeated, is associated with a raised risk of future multiple sclerosis, possibly due to initiation of an autoimmune process in the central nervous system.”

“Another reason to protect adolescents against brain damage, particularly if they are at risk of repetitive trauma, such from sports-related injuries,” adds Prof. Montgomery.

According to the Centers for Disease Control and Prevention (CDC), concussion or another type of TBI was diagnosed in roughly 329,290 people in the United States who were treated for sports or recreational injuries in 2012.

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Fibromyalgia

Why do my legs and feet feel numb?

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Due to sitting in a position that exerts too much pressure on the nerves or restricts blood flow, a person may have numbness in their legs and feet. Long-term or inexplicable numbness, on the other hand, might indicate an underlying medical condition.

Conditions including multiple sclerosis (MS), diabetes, peripheral artery disease, and fibromyalgia can cause long-term numbness or tingling in the legs and feet. The feeling might be felt across the leg, below the knee, or in various parts of the foot.

In this post, we’ll look at some of the causes of numbness in the legs and feet, as well as the symptoms and treatments available.

Symptoms

feet Numbness

Numbness is just one of the many symptoms connected with numbness, whether momentary and chronic.

Many people who have numbness in their legs and feet often have other symptoms that occur at the same time or in waves, such as:

  • tickling
  • itching
  • a crawling feeling under the skin
  • tingling
  • burning

Causes 

Because of their position, a person’s legs frequently go numb. Chronic or long-term numbness in the feet and legs, on the other hand, is usually always an indication of a medical condition.

The following are some of the conditions that might cause numbness in the feet and legs:

Posture

The most common cause of transient numbness in the legs and feet is poor posture that puts pressure on nerves or reduces blood flow in the lower limbs. The medical word for transitory (temporary) paresthesia is what many people refer to when their leg “falls asleep.”

The following habits might lead the feet and legs to fall asleep:

  • sitting on the feet
  • wearing pants, socks, or shoes that are too tight
  • sitting or kneeling for long periods
  • crossing the legs for too long

Multiple sclerosis

Sensory nerve loss causes numbness in a small area of the body or across the limbs in people with multiple sclerosis (MS). Although MS-related numbness usually only lasts a short time, it can be severe enough to be debilitating.

Stokes and mini-strokes

Strokes and mini-strokes can harm the brain, altering how the mind perceives and processes nerve impulses. A stroke or mini-stroke can result in numbness in various parts of the body, which can be brief or long-term.

Diabetes

Diabetic neuropathy is a kind of nerve injury that occurs in some people. Diabetic neuropathy can result in numbness, tingling, and discomfort in the feet, as well as the legs if the condition is severe.

Injury

Nerves in the trunk, spine, hips, legs, ankles, and feet can be compressed, causing numbness in the feet and legs.

Tarsal tunnel syndrome

Tarsal tunnel syndrome is caused by a compressed, pinched, or injured nerve that goes down the back of the leg, along the inside of the ankle, and into the foot.

On the inside of the ankle, the tarsal tunnel is a tiny space. Numbness, burning, tingling, and shooting pain in the ankles, heels, and feet are common people of tarsal tunnel syndrome.

Lower back issues and sciatica

Compression of the nerves leading to the legs can be caused by problems in the lower back, such as a breakdown or herniation of spinal discs, resulting in numbness or sensory difficulties.

Sciatica is a condition in which the sciatic nerve, which travels from the lower back to the legs, is irritated. A person may have numbness or tingling in their legs or feet if this nerve becomes inflamed or constricted.

Tumors and other non-cancerous growths

Tumors, cysts, abscesses, and benign (non-cancerous) growths can push against the brain, spinal cord, or any part of the legs or feet. This pressure can cause numbness in the legs and feet by restricting blood flow.

Peripheral artery disease

The peripheral blood arteries in the legs, arms, and stomach constrict as a result of peripheral arterial disease (PAD), limiting the volume of blood they can pump and lowering blood flow. One of the most prevalent parts of the body affected by PAD is the legs.

When walking or moving upstairs, most people with PAD suffer discomfort and tightness in their legs and hips. Leg numbness and weakness are also common people of PAD.

PAD symptoms usually subside after a few minutes of relaxation.

Fibromyalgia

Fibromyalgia is a chronic or long-term condition that causes widespread pain, aching, and soreness throughout the body. Numbness and tingling in the hands and feet are also common people of fibromyalgia.

The majority of people who have fibromyalgia have a range of symptoms, including:

  • memory problems and difficulty thinking clearly, sometimes called fibro-fog
  • restless leg syndrome
  • stiffness and soreness for no apparent reason, especially in the morning or after sleeping
  • chronic exhaustion

For at least 3 months, almost everyone with fibromyalgia has symptoms in more than one section of their body. Fibromyalgia is unlikely to be the cause of numbness in the legs and feet if it is not accompanied by other symptoms or is not long-term.

Use of alcoholic beverages

Alcohol’s toxins can induce nerve damage, which can lead to numbness, especially in the feet.

Nerve damage caused by chronic or heavy alcohol intake can also induce numbness. Reduced levels of B vitamins, such as B-1 (thiamine), B-9 (folate), and B-12, are connected to nerve damage induced by heavy alcohol consumption.

Treatment

The best way to treat numb legs and feet is to figure out what’s causing them.

Medication

Long-term numbness in the legs and feet can be treated with the following medications:

  • Gabapentin and pregabalin. Medications that block or modify nerve signals may assist to alleviate numbness caused by fibromyalgia, MS, and diabetic neuropathy.
  • Corticosteroids. Some corticosteroids can assist with persistent inflammation and numbness caused by diseases like MS.
  • Antidepressants. Duloxetine and milnacipran are two antidepressants that have been authorized for the treatment of fibromyalgia.

Home remedies

The following are some home treatments for numbness in the legs and feet that may help:

  • Epsom salt baths. Magnesium, a component found in Epsom salts, is believed to improve blood flow and circulation. Epsom salts may be purchased over the internet.
  • Stress management and mental strategies. People with persistent numbness, such as MS and fibromyalgia, should attempt to concentrate on the fact that the numbness is typically transient and will go away on its own. The symptoms of central nervous system disorders are also exacerbated by stress.
  • Rest. Nerve pressure is one of the most common causes of leg and foot numbness, and usually improves with rest.
    Ice. Ice can aid in the reduction of edema that puts pressure on nerves. Several times a day, apply cold compresses or wrapped icepacks to numb legs and feet for 15 minutes at a time.
    Heat. Heat can assist release tight, painful, or strained muscles that might produce numbness by putting pressure on nerves. Overheating numb legs and feet, on the other hand, can exacerbate inflammation and produce discomfort and numbness.
  • Sleep. Many chronic illnesses that cause numbness in the legs and feet have been shown to worsen when people don’t get enough sleep.
  • A nutritious and well-balanced diet. Nerve damage caused by malnutrition, particularly vitamin B deficiency, can result in numbness. Chronic inflammation and discomfort, which can produce numbness, can be reduced by getting adequate vitamins and other minerals.
  • Reduced or complete abstinence from alcohol. Toxins found in alcohol can induce nerve damage and numbness. Alcohol can also exacerbate the symptoms of chronic pain and inflammatory disorders, as well as create flare-ups.
  • Massage. Massage can assist enhance blood flow and alleviate discomfort in numb legs and feet.
  • Exercise. A lack of activity can cause the heart and blood arteries to weaken, limiting their capacity to pump blood to the lower limbs. Yoga, Pilates, and tai chi are examples of activities that help improve blood flow and relieve chronic inflammation or discomfort.
  • Supportive devices. Nerve pressure caused by injuries, tarsal tunnel syndrome, or flat feet can be relieved using braces and specially tailored footwear.

Alternative therapies

Alternative remedies have been demonstrated to help alleviate the symptoms of numbness in the legs and feet caused by several diseases. The following therapies are available:

  • hydrotherapy
  • mindfulness meditation
  • guided imagery
  • vitamin B supplementation (especially B-3, B-6, and B-12)
  • massage
  • reflexology
  • acupuncture
  • biofeedback

When to see a doctor

Consult a doctor if you have numbness in your legs or feet that:

  • lasts for long periods
  • is accompanied by permanent or long-term changes in the color, shape, or temperature of the legs and feet
  • is not related to postural habits or lifestyle factors, such as tight clothing and footwear
  • is accompanied by any other chronic symptoms

Conclusion

Numbness in the legs and feet is a frequent problem, but if it persists, it might indicate an underlying medical condition.

Anyone who has unexplained numbness that is persistent, frequent, severe, debilitating, or accompanied by other chronic symptoms should consult a physician for a diagnosis and treatment options.

Sources:

  • https://www.foundationforpn.org/what-is-peripheral-neuropathy/causes/alcohol/
  • https://www.msfocusmagazine.org/Magazine/Magazine-Items/13-Points-about-Paresthesia
  • https://www.niams.nih.gov/health-topics/fibromyalgia/advanced#tab-symptoms
  • https://www.medicalnewstoday.com/articles/321560
  • https://www.ninds.nih.gov/Disorders/All-Disorders/Paresthesia-Information-Page

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Bones / Orthopedics

What you should know about MS-related walking issues, including how to test and treat them

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Multiple sclerosis (MS) is a central nervous system illness that affects people. It can restrict mobility, making it difficult to walk.

According to the National MS Society, the disease affects around 1 million people in the United States. One of the most prevalent mobility-related symptoms is difficulty walking.

This post discusses how MS can damage one’s ability to walk, the mobility tests used by physical therapists, and the many therapies available.

MS walking difficulties

MS walking difficulties

The central nervous system, which includes the brain, spinal cord, and optic nerves, is affected by MS. Damage to this system, which controls how a person moves and reacts to stimulus, might result in mobility issues.

An immune system problem in a person with MS causes the immune system to attack healthy tissue, in this case myelin.

A fatty substance that covers and insulates nerve fibers is known as myelin. It also aids in the rapid transmission of signals via the neurons.

If myelin is injured or destroyed, the nerve it protects may lose its ability to receive impulses correctly. This means that messages traveling through the nerve may be disrupted or never reach their destination.

MS-related movement difficulties are thought to be caused by myelin loss in the cerebellum, according to experts. The cerebellum is a part of the brain that aids with movement and coordination.

These mobility issues may include:

  • muscle tightness, stiffness, or spasms
  • problems with balance
  • severe numbness in the feet
  • loss of position sense, which involves knowing where the feet are when walking
  • fatigue
  • muscle weakness
  • trouble with vision
  • cognitive issues
  • unstable walking

Gait changes due to MS

The gait of a person is their walking pattern. According to a 2018 study, 50–80 percent of people with MS suffer balance and gait problems.

Other research from 2018 reports a range of gait alterations, including:

  • a slow walking speed
  • a reduced range of motion in the leg joints
  • a smaller step length
  • reduced stability
  • difficulty lifting the front part of the foot, which is called “foot drop”

Gait issues can increase the risk of falling. According to the National MS Society, 50–70% of people with MS experienced falls in the two–six months before to taking the survey.

MS walking tests

A person with MS may be asked to take a walking test by a physical therapist. This entails walking a predetermined distance while the therapist assesses their gait.

The findings may aid physical therapists in more successfully treating gait disorders.

Timed 25-foot walk

This requires a 25-foot walk (ft). A person should walk as swiftly as they feel comfortable, and assistive aids such as a cane may be used.

The person’s physical therapist will time them while they walk to a distance marker and, possibly, as they return. The purpose is to assess the person’s gait speed, which is a useful indicator of walking ability.

Ambulation index

This is comparable to the timed 25-foot walk test, which has mostly supplanted it.

Walking 25 feet as quickly as possible while being timed is also part of the ambulation index. The purpose is to quantify mobility rather than gait speed in this case.

A person’s score ranges from 0 to 10. They have a score of 0 if they are totally active, and a score of 10 if they are unable to get out of bed.

Dynamic gait index

This entails assessing a person’s walking style, as well as their balance and potential for falling.

To complete this test, a person must walk and perform additional activities, such as:

  • changing speed
  • turning their head left and right or up and down
  • avoiding obstacles
  • turning on the spot
  • climbing stairs

The 12-item MS walking scale

This questionnaire, often known as the MSWS-12, contains 12 statements about how MS affects one’s ability to walk.

The person being tested will be asked to rate each statement on a scale of 1 to 5 by the healthcare expert administering the test.

A “1” indicates that the person has not had the experience described in the statement. A score of 5 indicates that they have had a particularly bad experience with it.

Timed up-and-go test

This is how physical therapists time how long it takes a person to get out of a chair, walk 10 ft, and then return to the chair.

According to the Centers for Disease Control and Prevention (CDC), if it takes more than 12 seconds, the person is at risk of falling.

Treatment options and self-management techniques

Physical treatment, according to the National MS Society, can help with a variety of gait issues.

To assist a person adapt, a physical therapist may propose vestibular activities that cause imbalance. These activities could include:

  • head or eye movements
  • altering visual input
  • walking on different kinds of surfaces

They may also encourage a person to do stretching exercises to improve:

  • flexibility
  • strength
  • cardiovascular fitness
  • balance
  • coordination
  • relaxation

Some prescription drugs can enhance a person’s gait by reducing muscular stiffness and speeding up walking.

People with MS may benefit from a variety of assistive equipment, such as canes, crutches, or braces.

Anyone who has difficulty walking should get medical advice on how to lessen their risk of falling. This could entail:

  • not wearing high heels
  • avoiding slippery surfaces
  • removing obstacles and trip hazards from the home
  • keeping walking areas well lit, especially at night

Conclusion

MS can make it difficult for nerves to transmit electrical signals as they should. This can lead to mobility issues, such as difficulty walking.

Physical therapists employ a variety of tests to determine how MS affects a person’s gait and to improve treatment options.

Stretching and exercising, as well as utilizing assistive equipment and maybe taking drugs, can all help with mobility issues. Anyone with MS who is having trouble walking should speak with a member of their medical team.

Sources

  • https://www.sralab.org/rehabilitation-measures/12-item-multiple-sclerosis-walking-scale
  • https://www.nationalmssociety.org/For-Professionals/Researchers/Resources-for-MS-Researchers/Research-Tools/Clinical-Study-Measures/Ambulation-Index-(AI)
  • https://www.medicalnewstoday.com/articles/ms-walking
  • https://www.sciencedirect.com/science/article/abs/pii/B978044463916500015X?via%3Dihub
  • https://www.nationalmssociety.org/What-is-MS/Definition-of-MS
  • https://www.sralab.org/rehabilitation-measures/dynamic-gait-index
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5862880/
  • https://nmsscdn.azureedge.net/NationalMSSociety/media/MSNationalFiles/Brochures/Brochure-GaitOrWalkingProblems-TheBasicFacts_FINAL.pdf
  • https://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Brochures/Brochure-Stretching-for-People-with-MS.pdf
  • https://www.nationalmssociety.org/What-is-MS/How-Many-People
  • https://www.msif.org/about-ms/symptoms-of-ms/movement-and-coordination-problems/
  • https://www.nationalmssociety.org/For-Professionals/Researchers/Resources-for-MS-Researchers/Research-Tools/Clinical-Study-Measures/Timed-25-Foot-Walk-(T25-FW)
  • https://www.cdc.gov/steadi/pdf/TUG_test-print.pdf
  • https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Walking-Gait-Balance-Coordination
  • https://www.msif.org/about-ms/what-is-ms/

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