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190 </head> 191 192<body class="wp-singular page-template-default page page-id-10 page-child parent-pageid-6 wp-theme-ampyra affect self-assessment" data-template="base.twig"> 193 194 <a class="skip-link screen-reader-text" href="#content">Skip to content</a> 195 <header id="header" class="header clearfix"> 196 <div class="top-nav sitewidth clearfix" id="top-nav"> 197 <a href="https://ampyra.com" class="logo-ampyra" rel="home"><img src="https://ampyra.com/app/themes/ampyra/images/logo-ampyra.png" alt="AMPYRA"></a> 198 <img src="https://ampyra.com/app/themes/ampyra/images/logo-ampyra-sm.png" alt="AMPYRA" class="print-only print-logo"> 199 <span class="d-md-none md-guide-link"><a href="https://ampyra.com/app/themes/ampyra/pdf/medication-guide.pdf" target="_blank">Medication Guide</a></span> 200 <nav id="nav-main" class="d-none d-md-block top-nav-links" role="navigation"> 201 <ul> 202 <li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-32"> 203 <a target="_self" href="https://ampyra-hcp.com/hcp/home">For US Healthcare Professionals</a> 204 <ul> 205 </ul> 206 </li> 207 <li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-33"> 208 <a target="_self" href="/app/themes/ampyra/pdf/medication-guide.pdf">Medication Guide</a> 209 <ul> 210 </ul> 211 </li> 212 <li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-34"> 213 <a target="_self" href="/app/themes/ampyra/pdf/prescribing-information.pdf">Prescribing Information</a> 214 <ul> 215 </ul> 216 </li> 217 </ul> 218 </nav> 219 </div> 220 <div class="header-title sitewidth"> 221 <h1>Is MS Affecting My Walking?</h1> 222 <span class="header-disclaimer">For adults with MS-related walking difficulties</span> </div> 223 <div class="sticky-wrapper"> 224 <div class="sub-nav" id="sub-nav"> 225 <div class="sitewidth"> 226 <ul class="clearfix"> 227 <li><a href="/walking-and-ms/" class="">Walking <br>and MS</a></li> 228 <li><a href="/patient-videos/" class="">Real <br>Perspectives</a></li> 229 <li><a href="/self-assessment/" class="active">Assess <br>Your Walking</a></li> 230 </ul> 231 </div> 232 </div> 233 </div> 234 </header> 235 <a href="javascript:void(0);" id="menu-btn" class="menu-btn"> 236 <span id="menu-btn-text" class="off">MENU</span><span class="on">Ã</span> 237 </a> 238 <div id="menu" class="menu hidden clearfix ie-menu"> 239 240 <div class="menu-container"> 241 <div class="menu-item menu-affect"> 242 <div class="menu-bg"> 243 <img class="menu-img" src="https://ampyra.com/app/themes/ampyra/images/menu/bg-menu-affect.jpg" alt="Feet walking through grass" style="left: 0px; top: -143px; height: 545px; width: 889px;"> 244 <video id="video-menu-affect" class="menu-video d-none d-md-block" volume="0" loop="" preload="" muted="" style="left: 0px; top: -120.336px; height: 499.672px; width: 889px;"> 245 <source src="https://ampyra.com/app/themes/ampyra/videos/home/menu-affect.mp4" type="video/mp4"> 246 <source src="https://ampyra.com/app/themes/ampyra/videos/home/menu-affect.webm" type="video/webm"> 247 <source src="https://ampyra.com/app/themes/ampyra/videos/home/menu-affect.ogv" type="video/ogg"> 248 </video> 249 250 <div class="menu-disclaimer2">Actor portrayal</div> 251 </div> 252 <div class="menu-context"> 253 <h6>Is MS Affecting My Walking?</h6> 254 <ul> 255 <li><a href="/walking-and-ms/">Walking <br>and MS</a></li> 256 <li><a href="/walking-and-ms/patient-videos">Real <br>Perspectives</a></li> 257 <li>
257<a href="/walking-and-ms/self-assessment">Assess <br>Your Walking</a></li> 258 </ul> 259 <button class="menu-status" aria-label="sub-menu expander"></button> 260 </div> 261 </div> 262 <div class="menu-item menu-learn"> 263 <div class="menu-bg"> 264 <img class="menu-img" src="https://ampyra.com/app/themes/ampyra/images/menu/bg-menu-learn.jpg" alt="Feet walking through grass" style="left: 0px; top: -107.5px; height: 474px; width: 889px;"> 265 <video id="video-menu-learn" class="menu-video d-none d-md-block" volume="0" loop="" preload="" muted="" style="left: 0px; top: -120.336px; height: 499.672px; width: 889px;"> 266 <source src="https://ampyra.com/app/themes/ampyra/videos/home/menu-learn.mp4" type="video/mp4"> 267 <source src="https://ampyra.com/app/themes/ampyra/videos/home/menu-learn.webm" type="video/webm"> 268 <source src="https://ampyra.com/app/themes/ampyra/videos/home/menu-learn.ogv" type="video/ogg"> 269 </video> 270 271 <div class="menu-disclaimer2">Actor portrayal</div> 272 </div> 273 <div class="menu-context"> 274 <h6>Learn About the Walking Pill</h6> 275 <ul> 276 <li><a href="/what-is-ampyra">What is <br>AMPYRA?</a></li> 277 <li><a href="/real-patient-videos">Walking with AMPYRA: <br> Actual Patient Videos</a></li> 278 <li><a href="/is-ampyra-right-for-you">Is AMPYRA <br>Right for You?</a></li> 279 <li><a href="/how-to-take-ampyra">How to Take <br>AMPYRA</a></li> 280 <li><a href="/cost-patient-assistance">Help With <br>AMPYRA Coverage</a></li> 281 </ul> 282 <button class="menu-status" aria-label="sub-menu expander"></button> 283 </div> 284 </div> 285 286 <div class="menu-item menu-stay"> 287 <div class="menu-bg"> 288 <img class="menu-img" src="https://ampyra.com/app/themes/ampyra/images/menu/bg-menu-stay.jpg" alt="A person waiting by a train" style="left: 0px; top: -304px; height: 844px; width: 800px;"> 289 <video id="video-menu-stay" class="menu-video d-none d-md-block" volume="0" loop="" preload="" muted="" style="left: 0px; top: -106.824px; height: 449.649px; width: 800px;"> 290 <source src="https://ampyra.com/app/themes/ampyra/videos/home/menu-stay.mp4" type="video/mp4"> 291 <source src="https://ampyra.com/app/themes/ampyra/videos/home/menu-stay.webm" type="video/webm"> 292 <source src="https://ampyra.com/app/themes/ampyra/videos/home/menu-stay.ogv" type="video/ogg"> 293 </video> 294 <div class="menu-disclaimer2">Actor portrayal</div> 295 </div> 296 <div class="menu-context"> 297 <h6>Stay on Track With <span class="nowrap">AMPYRA<sup>®</sup> <small>(dalfampridine)</small></span></h6> 298 <ul> 299 <li><a href="/treatment/expectations">What to <br>Expect</a></li> 300 <li><a href="/treatment/dosing">Do's and Don'ts <br>of Dosing</a></li> 301 <li><a href="/treatment/patient-support-services">Help With <br>AMPYRA Coverage</a></li> 302 <li><a href="/treatment/prescription-refills">Refilling <br>Your Prescription</a></li> 303 </ul> 304 <button class="menu-status" aria-label="sub-menu expander"></button> 305 <div class="menu-disclaimer1">For adults with MS-related walking difficulties</div> 306 307 </div> 308 </div> 309 <div class="menu-item menu-start"> 310 <div class="menu-bg"> 311 <img class="menu-img" src="https://ampyra.com/app/themes/ampyra/images/menu/bg-menu-start.jpg" alt="A person waiting by a train" style="left: 0px; top: -303px; height: 842px; width: 800px;"> 312 <video id="video-menu-start" class="menu-video d-none d-md-block" volume="0" loop="" preload="" muted="" style="left: 0px; top: -106.824px; height: 449.649px; width: 800px;"> 313 <source src="https://ampyra.com/app/themes/ampyra/videos/home/menu-start.mp4" type="video/mp4"> 314 <source src="https://ampyra.com/app/themes/ampyra/videos/home/menu-start.webm" type="video/webm"> 315 <source src="https://ampyra.com/app/themes/ampyra/videos/home/menu-start.ogv" t
315ype="video/ogg"> 316 </video> 317 <div class="menu-disclaimer2">Actor portrayal</div> 318 </div> 319 <div class="menu-context"> 320 <h6>How to Get Started on AMPYRA</h6> 321 <ul> 322 <li><a href="/prescription">Getting <br>Started</a></li> 323 <li><a href="/prescription/doctor-discussion-guide">Talking to <br>Your Doctor</a></li> 324 <li><a href="/prescription/coverage">AMPYRA Co-pay <br> and Support</a></li> 325 </ul> 326 <button class="menu-status" aria-label="sub-menu expander"></button> 327 <div class="menu-disclaimer1">For adults with MS-related walking difficulties</div> 328 329 </div> 330 </div> 331 332 <div class="menu-item menu-extra"> 333 <div class="menu-faq"> 334 <a href="/faq"><i class="icon"></i><strong>COMMON QUESTIONS</strong></a> 335 </div> 336 <hr> 337 <div class="medication-guide"> 338 <a href="https://ampyra.com/app/themes/ampyra/pdf/medication-guide.pdf" target="_blank"><i class="icon"></i><strong>MEDICATION GUIDE</strong></a> 339 </div> 340 </div> 341 </div> 342 <div id="nav-fixed-isi" class="isi-hackery"> 343 <div class="sitewidth"> 344 <div class="grid_12 isi-left"> 345 <div class="fixed-isititle"> 346 <h2>Indication</h2> 347 </div> 348 <div class="fixed-isicontent"> 349 <p>AMPYRA<sup>®</sup> (dalfampridine) Extended Release Tablets, 10 mg, is indicated to help improve walking in adults with multiple sclerosis (MS). This was demonstrated by an increase in walking speed.</p> 350 </div> 351 </div> 352 <div class="grid_12 isi-right"> 353 <div class="fixed-isititle"> 354 <h2>Important Safety Information</h2> 355 <span><label>See More</label></span> 356 </div> 357 <div class="fixed-isicontent"> 358 <p>Do not take AMPYRA if you have ever had a seizure, have certain types of kidney problems, or are allergic to dalfampridine (4-aminopyridine), the active ingredient in AMPYRA.</p> 359 </div> 360 </div> 361 </div> 362 </div> 363 </div> 364 <section id="content" role="main" class="pb-5 content-wrapper"> 365 <div class="context clearfix"> 366 <div class="hero"> 367 368 369<div id="content" class="content"> 370 <div class="context clearfix"> 371 <div class="panel"> 372 <div class="sitewidth"> 373 <h2>Is Your Walking Up to Speed?</h2> 374 <p>Do you try to compensate for your walking difficulty or feel you have to hide it? Do you avoid going to certain places or doing certain activities? It's important to notice changes in your walking and realize how they impact your day-to-day activities. </p> 375 <p>Answer these simple questions to assess your walking, then discuss the results with your doctor.</p> 376 <div class="small-callout"> 377 <div class="left"> 378 <i class="icon icon-time"></i> 379 <p>Estimated time: <span class="nowrap">2 minutes</span></p> 380 </div> 381 <div class="right"> 382 <i class="icon icon-download-blank"></i> 383 <p>Don't have time?<br> <a href="https://ampyra.com/app/themes/ampyra/pdf/self_assessment_empty.pdf?v=20251015" target="_blank">Download a blank copy of these questions.</a></p> 384 </div> 385 </div> 386 </div> 387 </div> 388 389 <div class="panel gray quiz-window"> 390 <div class="sitewidth"> 391 <div class="quiz-wrapper mobile-full"> 392 <form action="/walking-and-ms/self-assessment/download/" name="SAEmail"> 393 <ul class="quiz container clearfix" id="quiz"> 394 395 <li class="clearfix focus" data-question="1"> 396 <div class="quiz-question grid_20 prefix_2">Since developing MS, have you noticed that your walking is getting worse?</div> 397 <div class="quiz-context grid_24 alpha"> 398 <div class="quiz-num grid_sub_3">
399 <span>1</span> 400 </div> 401 <div class="quiz-options grid_sub_21"> 402 <a href="#SA_Q1_1">Not at all</a> 403 <a href="#SA_Q1_2">A little</a> 404 <a href="#SA_Q1_3">Moderately</a> 405 <a href="#SA_Q1_4">Quite a bit</a> 406 <a href="#SA_Q1_5">Extremely</a> 407 <input type="hidden" name="SA1" value=""> 408 </div> 409 </div> 410 </li> 411 <li class="clearfix " data-question="2"> 412 <div class="quiz-question grid_20 prefix_2">Have you ever noticed that your walking makes it difficult to keep up with friends or family members?</div> 413 <div class="quiz-context grid_24 alpha"> 414 <div class="quiz-num grid_sub_3"> 415 <span>2</span> 416 </div> 417 <div class="quiz-options grid_sub_21"> 418 <a href="#SA_Q2_1">Not at all</a> 419 <a href="#SA_Q2_2">A little</a> 420 <a href="#SA_Q2_3">Moderately</a> 421 <a href="#SA_Q2_4">Quite a bit</a> 422 <a href="#SA_Q2_5">Extremely</a> 423 <input type="hidden" name="SA2" value=""> 424 </div> 425 </div> 426 </li> 427 <li class="clearfix " data-question="3"> 428 <div class="quiz-question grid_20 prefix_2">Have you ever found yourself late for an appointment, missed a train or bus because you couldn't walk fast enough?</div> 429 <div class="quiz-context grid_24 alpha"> 430 <div class="quiz-num grid_sub_3"> 431 <span>3</span> 432 </div> 433 <div class="quiz-options grid_sub_21"> 434 <a href="#SA_Q3_1">Not at all</a> 435 <a href="#SA_Q3_2">A little</a> 436 <a href="#SA_Q3_3">Moderately</a> 437 <a href="#SA_Q3_4">Quite a bit</a> 438 <a href="#SA_Q3_5">Extremely</a> 439 <input type="hidden" name="SA3" value=""> 440 </div> 441 </div> 442 </li> 443 <li class="clearfix " data-question="4"> 444 <div class="quiz-question grid_20 prefix_2">Are there days or periods of time when your walking is noticeably slower?</div> 445 <div class="quiz-context grid_24 alpha"> 446 <div class="quiz-num grid_sub_3"> 447 <span>4</span> 448 </div> 449 <div class="quiz-options grid_sub_21"> 450 <a href="#SA_Q4_1">Not at all</a> 451 <a href="#SA_Q4_2">A little</a> 452 <a href="#SA_Q4_3">Moderately</a> 453 <a href="#SA_Q4_4">Quite a bit</a> 454 <a href="#SA_Q4_5">Extremely</a> 455 <input type="hidden" name="SA4" value=""> 456 </div> 457 </div> 458 </li> 459 <li class="clearfix " data-question="5"> 460 <div class="quiz-question grid_20 prefix_2">Are you having trouble making it in time to the bathroom or to answer the phone or doorbell?</div> 461 <div class="quiz-context grid_24 alpha"> 462 <div class="quiz-num grid_sub_3"> 463 <span>5</span> 464 </div> 465 <div class="quiz-options grid_sub_21"> 466 <a href="#SA_Q5_1">Not at all</a> 467 <a href="#SA_Q5_2">A little</a> 468 <a href="#SA_Q5_3">Moderately</a> 469 <a href="#SA_Q5_4">Quite a bit</a> 470 <a href="#SA_Q5_5">Extremely</a> 471 <input type="hidden" name="SA5" value=""> 472 </div> 473 </div> 474 </li> 475 <li class="clearfix finished-container" id="finished-container1" data-question="6"> 476 <div class="thankyouheading grid_24"> 477 <h4>Thank You!</h4> 478 <p>
478How would you like to receive your Self-Assessment? (Choose any or all options.)</p> 479 </div> 480 481 <div class="grid_10"> 482 <div> 483 <a href="javascript:void(0);" id="downloadPDF" class="button download"><span>Download my completed <span class="nowrap">Self-Assessment</span></span></a> 484 </div> 485 </div> 486 </li> 487 </ul> 488 </form> 489 <div class="quiz-control"> 490 <button id="quizBack" aria-label="back" class="disabled"></button> 491 <button id="quizNext" aria-label="next"></button> 492 </div> 493 </div> 494 </div> 495 496 </div> 497 498 <div class="panel pctaWrapper pctaWrapper1 free_trail"> 499 <div class="sitewidth"> 500 <div class="pcta"> 501 <i class="icon icon-next-step"></i> 502 <a href="/prescription/coverage" id="0copaybanner"> 503 <h5>$0 Co-pay*</h5> 504 <p> 505 Eligible commercially insured patients may receive AMPYRA for as little as $0.* Offer not valid for patients whose prescriptions are reimbursed by medicare, medicaid or other state or federal healthcare programs, or where <span class="text-nowrap">prohibited by law.</span> 506 </p> 507 <small>*Click here to see full terms, conditions and eligibility criteria. For Questions, <span class="text-nowrap">call 855-866-9255.</span></small> 508 </a> 509 </div> 510 </div> 511</div> 512 <div class="panel pagination"> 513 <div class="sitewidth clearfix"> 514 <div class="page-prev"> 515 <a href="/walking-and-ms/patient-videos">PREV <span>| Real Perspectives</span></a> 516 </div> 517 <div class="page-next"> 518 <a href="/what-is-ampyra"><span>What is AMPYRA? | </span>NEXT</a> 519 </div> 520 </div> 521 </div> 522 </div> 523</div> 524 </div> 525 </div> 526 527 528<div id="inline-isi" class="inline-isi container"> 529 <div id="fixed-isi" class="isi-hackery"> 530 <div class="sitewidth"> 531 <div class="grid_12 isi-left"> 532 <div class="fixed-isititle"> 533 <h2>Indication</h2> 534 </div> 535 <div class="fixed-isicontent"> 536 <p>AMPYRA<sup>®</sup> (dalfampridine) Extended Release Tablets, 10 mg, is indicated to help improve walking in adults with multiple sclerosis (MS). This was demonstrated by an increase in walking speed.</p> 537 </div> 538 </div> 539 <div class="grid_12 isi-right"> 540 <div class="fixed-isititle"> 541 <h2>Important Safety Information</h2> 542 <span><label>See More</label></span> 543 </div> 544 <div class="fixed-isicontent"> 545 <p>Do not take AMPYRA if you have ever had a seizure, have certain types of kidney problems, or are allergic to dalfampridine (4-aminopyridine), the active ingredient in AMPYRA.</p> 546 </div> 547 </div> 548 </div> 549 </div> 550 551 <div class="isi sitewidth" id="isi-content"> 552 <h2>Indication & Important Safety Information</h2> 553 <div> 554 <h3>INDICATION</h3> 555 <p><span class="isi-indication">AMPYRA<sup>®</sup> (dalfampridine) Extended Release Tablets, 10 mg, is indicated to help improve walking in adults with multiple sclerosis (MS). This was demonstrated by an increase in walking speed.</span></p> 556 557 <h3>IMPORTANT SAFETY INFORMATION</h3> 558 <p>Do not take AMPYRA if you:</p> 559 <ul class="bullets"> 560 <li>have ever had a seizure,</li> 561 <li>have certain types of kidney problems, or</li> 562 <li>are allergic to dalfampridine <span class="nowrap">(4-aminopyridine),</span> the active ingredient in AMPYRA.</li> 563 </ul> 564 565 <p>Take AMPYRA exactly as prescribed by your doctor.</p> 566 567 <p>Before taking AMPYRA, tell your doctor if you:</p> 568 <ul class="bullets"> 569 <li>have any other medical conditions</li> 570 <li>are taking compounded <span class="nowrap">4-aminopyridine</span></li> 571 <li>are taking any other prescription or OTC medicines, such as cimetidine</li> 572 <li>are pregnant or plan to become pregnant. It is not known if AMPYRA will harm your unborn baby.</li> 573 <li>are breastfeeding or plan to breastfeed. It is not known if AMPYRA passes into your breast milk. Talk with your healthcare provider about the best way to feed your baby if you take AMPYRA.</li> 574 </ul> 575 <p>Stop taking AMPYRA and call your doctor right away if you have a seizure while taking AMPYRA. You could have a seizure even if you never had a seizure before. Your chance of having a seizure is higher if you take too much AMPYRA or if your kidneys have a mild decrease of function, which is common after age 50. Your doctor may do a blood test to check how well your kidneys are working before you start AMPYRA.</p> 576 577 <p>AMPYRA should not be taken with other forms of <span class="nowrap">4-aminopyridine</span> (4-AP, fampridine), since the active ingredient is the same.</p> 578 <p>AMPYRA may cause dizziness or vertigo. If you have these symptoms do not drive, operate machinery or do other dangerous activities.</p> 579 <p>AMPYRA may cause serious side effects, including severe allergic reactions. Stop taking AMPYRA and call your doctor right away or get emergency medical help if you have shortness of breath or trouble breathing, swelling of your throat or tongue, or hives.</p> 580 581 <p>The most common side effects for AMPYRA in MS patients were urinary tract infection; trouble sleeping; dizziness; headache; nausea; weakness; back pain; problems with balance; multiple sclerosis relapse; burning, tingling, or itching of your skin; irritation in your nose and throat; constipation; indigestion; and pain in your throat.</p> 582 583 <p><strong>Please see the <a href="https://ampyra.com/app/themes/ampyra/pdf/medication-guide.pdf?v=2" target="_blank">
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