ALS Flashcards
what is ALS
most common MND - aka lou gehrig’s
rapidly progressive neurodegenerative that affects MN and corticospinal tracts
combined upper and lower motor signs
UMN findings in ALS
spasticity
hyperreflexia
pathological reflex
LMN findings in ALS
muscle weakness
atrophy
fasciculations
cramps
abdominal cramps - red flag
bulbar findings in ALS
spastic dysarthria: monotone and low pitch; UMN
flaccid dysarthria: wet and nasal; LMN
dysphagia
PBA
respi dysfunction
what is ALS cachexia
weight loss, atrophy and reduced calorie intake
reduced calorie intake - d/t dysphagia
atrophy - d/t muscles not being used since MN is damaged
hierarchy of initial sx in ALS
leg weakness - balance prob and sprains
arm weakness - deltoids
bulbar
generalized weakness - rare
_____ is a prominent feature of ALS
fasciculations that develop insidiously and slowly
usually normal in ALS
mental status
sensory CN function
sensation
cerebellar - except balance prob d/t weakness
CN 3,4,6
onufrowicz nuclues - bowel and bladder
spinocerebellar tracts
onset if classic ALS
UMN, LMN and bulbar
onset if progressive bulbar palsy
bulbar
onset if progressive lateral sclerosis
UMN onset
onset if progressive muscular atrophy
LMN
epidemiology in ALS
M > F but if F affected worse prog
58 yo - rare adolescence
inc risk of ALS
smokers > alcohol
high fat intake
high glutamate intake
discuss progressive/primary lateral sclerosis
affects corticospinal and spares LMN
spinal onset and rarely bulbar
initial: LE spasticity –> pathological reflexes and detrusor hyperactivity
LACK OF LMNL sx
discuss hereditary spastic paraplegia
affects CST and DCML - mild to mod
progressive spasticity
LE weakness
hypertonic bladder
impaired vibration
discuss tropical spastic paraparesis
usually in tropical areas - carribean, equatorial areas, mga south
optic neuropathy, cerebellar ataxia or polyneuropathy
viral - (+) serology
discuss progressive muscular atrophy
chromatolysis of MN of SC and brainstem - ant horn cell
distal leg weakness and atrophy –> UE>LE
bulbar wala initially
discuss progressive bulbar palsy
affects CN 9 and 10
dysphagia, dec gag, weakness of palate, facial and tongue fasciculations
pneumonia - usual cause of death
parts of CNS usually affected by ALS
motor cortex
corticospinal tracts
ant horn cell
poor prognosticating factors of ALS
> 40-60 yo
bulbar or pulmonary affectation
short tine bet onset and dx
predominance of LMN
women
pharmacologic tx for ALS
riluzole - 100 mg qd
can only slow
main characteristic of ALS treated by PT
weakness and fatigue
resistance training in ALS
12 wk mod resistance program
but not to point of exhaustion
signs of over exhaustion
weaker 30 mins p exercise
excessive soreness 24-48 hrs p exercise
severe cramps, heaviness and shortness of breath
aerobic training in ALS
improves physical and mental
pool therapy - midchest height at 92-95F
low impact aerobics
in-patient: hallway amb
