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Multiple Sclerosis Mobility Concerns in Multiple Sclerosis—Studies and Surveys on US Patient Populations of Relevance to Nurses Jong-mi Lee, NP 1 and Jeffrey Dunn, MD 2 1. Nurse Practitioner; 2. Neurologist, Stanford Multiple Sclerosis Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, California, US Abstract Despite significant advances in treatments and therapies for multiple sclerosis (MS) over the last two decades, there remains no effective treatment that can definitively halt the progression of functional impairments in MS. Impaired mobility, walking in particular, has been observed in early MS disease, and cross-sectional surveys according to MS clinical criteria have shown that approximately 50 % of existing patient populations with MS require mobility support, such as wheelchairs or walking aids, some or all of the time. Loss of mobility is one of the most disabling effects of MS, and adversely affects independence, employment, and quality of life. Additionally, as patients experience mobility loss, their ability to perform activities of daily living (ADL) decreases and dependence on the assistance of others increases. The stress and physical burden of caring for a friend or relative with MS may affect the health of caregivers and increase their own requirement for healthcare resources. The identification of therapeutic options for improving impaired mobility and coping with disability represents an important aspect of patient management. This review will discuss current published literature on mobility matters in MS, how they affect the patient, and how they are measured and treated, with inclusion of the perspective of a MS nurse specialist. Keywords Multiple sclerosis, impaired mobility, assessment, therapeutic options for mobility, nurse practitioners, caregivers Disclosure: Jong-Mi Lee, NP, has served on nursing advisory boards for Biogen Idec, Teva Neuroscience, and Genzyme. Jeffrey Dunn, MD, has a patent pending for a biomarker to predict treatment response in multiple sclerosis (MS). He has received grant support for clinical research from the Accelerated Cure Project, Genzyme, Roche/Genentech, and Actelion. He has served on scientific advisory boards for Biogen Idec, Teva Neuroscience, and Genzyme. He has received honoraria from the National MS Society and from PRIME ® Continuing Medical Education. Acknowledgments: Editorial assistance was provided by James Gilbart at Touch Medical Media. Received: May 31, 2013 Accepted: July 22, 2013 Citation: US Neurology, 2013;9(1):17–23 Correspondence: Jeffrey Dunn, MD, Stanford Multiple Sclerosis Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA 94305-5235, US. E: jeffdunn@stanford.edu Support: The publication of this article was funded by Acorda. The views and opinions expressed are those of the authors and not necessarily those of Acorda. Multiple sclerosis (MS) is a chronic inflammatory-demyelinating disease caused by intermittent and recurrent episodes of multifocal inflammation in the central nervous system (CNS), which results in the demyelination and transection of axons in the brain, optic nerve, and spinal cord. This damage to the neuronal pathways affects signal conduction, causing neurologic disabilities, such as vision problems, difficulty walking, weakness, imbalance, sensory loss, pain, cognitive changes, spasticity, and bladder or bowel dysfunction. 1 MS affects approximately 2.5 million people worldwide, 2 with the majority of people diagnosed between the ages of 20 and 50. 3 Women are more often affected by MS than men, and it is more prevalent in people of northern European descent than in those of other ancestries. 3 In many people with MS, mobility is affected early in the disease, even when clinical measures of disability are minimally altered. 4 © To u c h M Ed ic a l MEd ia 2013 Mobility is defined by the International Classification of Functioning, Disability, and Health (ICF) as “… moving by changing body position or location or by transferring from one place to another by carrying, moving, or manipulating objects, by walking, running or climbing, and by using various forms of transportation …” It has been estimated that 80  % of people with MS (as defined by a previous version of the McDonald diagnostic criteria of 2005) 5 will experience impaired mobility to some degree, within 10–15 years of their initial diagnosis 6 although this figure is decreasing with the widespread use of disease-modifying therapies (DMTs) that delay disability progression. Difficulty with walking is the primary factor contributing to loss of mobility in MS, is often the most visible sign of MS, 7,8 and constitutes one of the most feared and disabling neuromuscular deficits associated with the disease. 8–10 Walking impairment represents a particular concern of those living with 17