Research suggests that roughly half those with multiple sclerosis (MS) will need some assistance with walking — either with a cane, a walker, or other assistive device — within 15 years of their diagnosis, according to the National Multiple Sclerosis Society (NMSS). This may be the result of muscle weakness or balance issues associated with the condition, or other symptoms such as fatigue, pain, and vision problems.

However, that doesn’t mean that people with multiple sclerosis need to give up on being able to get around on their own. Indeed, experts suggest there are many steps people with MS can take to maintain their mobility for as long as possible.

“Difficulty walking is among the most common of the symptoms that first bring a person with undiagnosed MS to the clinic,” notes Alexius E. Sandoval, MD, a specialist in rehabilitation medicine at Johns Hopkins Physical Medicine and Rehabilitation in Baltimore.

“It’s often the first noticeable symptom, and while we still can’t ‘cure’ or reverse MS, we can help maintain the function that you do have, use compensatory strategies, and keep you moving for as long as possible,” Dr. Sandoval says.

Here are eight things you can try to stay mobile with multiple sclerosis:

1. Physical Therapy

Physical therapists (PTs) evaluate the body’s ability to move and function, then look for strategies to strengthen or compensate for weaknesses or other problems.

Valerie Block, a physical therapist conducting research at the University of California San Francisco Medical Center, says physical therapy for a person with MS might include a program of exercises and stretches, as well as training in using walking aids like canes, crutches, scooters, or wheelchairs. The idea, she says, is to keep you safe while restoring confidence in your legs and balance.

2. Occupational Therapy

Although occupational therapy (OT) is a separate discipline from PT, Block says the goals of OT and PT are essentially the same: increasing independence, safety, and quality of life during daily activities such as personal care, hobbies, family life, and work.

To facilitate walking, Block says occupational therapists usually work with physical therapists to train people with MS to use assistive devices and to simplify tasks at home.

Ideally, Sandoval adds, therapists may visit a patient’s home to perform a home evaluation and offer advice on what people with MS can do to make their homes safer, more accessible, and compatible with their limitations and needs.

“We may advise people to remove rugs or pieces of furniture they can trip over or to install ramps and grab bars,” he says.

3. Aerobic Exercise

Historically, Block says, it was thought that exercise was bad for people with MS because it can increase the fatigue they often experience. However, she says, now it’s generally accepted that a customized exercise program tailored to the needs of the individual can help improve energy levels as well as endurance, balance, and strength, all of which can lead to better walking and better overall quality of life.

While the types of exercises recommended differ from person to person, those aimed at improving walking generally focus on maintaining leg-muscle strength and, if necessary, weight loss, Block notes.

“Maintaining a healthy weight is crucial in MS,” she says. “The less weight you carry around, the less strain on the legs and the better balance you have.”

4. Walking Aids for Mobility and Independence

Although the goal of most MS treatment plans is to maintain mobility without the need for assistance for as long as possible, people who have MS will likely need to use an assistive device at some point.

Sandoval recommends working with a multidisciplinary team of specialists — including physicians, physical therapists, occupational therapists, and orthotists (specialists who fit orthotic devices or braces) — to choose and learn to use the right device.

“People are usually initially resistant to using things like canes to get around,” Block says. “People see reliance on assistive devices as a loss of freedom. But these devices can actually help people maintain their freedom by enabling them to get around safely.”

5. Working With a Podiatrist

The services of a podiatrist or other foot-care specialist may be helpful as well. Foot health can sometimes be a serious issue for people with MS, Sandoval says, and podiatrists can help in a number of ways, from trimming toenails (if a person is unable to do it himself) to treating foot ulcers. Podiatrists can also recommend shoe inserts or prescription shoes as needed.

6. Botox to Reduce Spasticity

Botox (onabotulinumtoxinA) is a neurotoxin that temporarily blocks connections between targeted nerves and muscles. Its role in MS is to reduce spasticity by weakening abnormally spastic muscles so that weaker muscles can function.

According to Sandoval, Botox is often used to treat a spastic foot drop, in which certain muscles in the leg and foot abnormally force the foot downward, disrupting the natural heel-to-toe gait. If you have this type of foot drop, your doctor may try to correct the problem by injecting Botox into the spastic muscles that force the foot downward.

The injections must be performed by a trained medical professional, and the effects of Botox usually last about three months, so injections are repeated when necessary to maintain the desired effect.

“The side effects are minimal if the injections are performed properly,” Sandoval says.

7. Functional Electrical Nerve Stimulation

For some types of walking problems, a functional electrical stimulation (FES) device can help. An FES device transmits a small electrical pulse to targeted nerves, which then cause certain muscles to contract. This may lift a foot drop or enable a leg to swing through properly.

The goal, Sandoval says, is to facilitate and retrain muscles to perform their intended function.

“Unfortunately, the device is expensive, and often not covered by insurance,” Sandoval says. But for properly selected individuals, it can work really well and can be more convenient to use than a brace.

8. Medication for Walking Help

Most medications prescribed to help people with MS walk better are designed to address specific symptoms that make walking difficult, such as fatigue, pain, or muscle spasticity.

One drug, called Ampyra (dalfampridine), is approved by the Food and Drug Administration (FDA) specifically to improve walking in people with multiple sclerosis. Ampyra comes in tablet form and is thought to improve the transmission of signals along nerves damaged in MS.

“It works well in about a third of MS patients, with minimal side effects,” Sandoval says.

However, Block says some people with MS “are wary about taking medication, because MS is a lifelong disease.” As a result, many specialists will recommend other approaches, like PT, OT, exercise, and orthotics, as a “first line of defense,” Block notes.

Regardless of what method or methods you choose, experts emphasize that it’s vital to follow the prescribed treatment plan. If you do, you should see the benefits.

“Because MS is a progressive disease, people too often get stuck on what they can’t do,” Block says. “Our job is to show them what they can do, and how these tools can help them get through their day.”