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PT 942 Phys Rehab II > ALS > Flashcards

ALS Flashcards

1
Q

What is ALS (2)?

A
  • Amyotrophic Lateral Sclerosis (Lou Gehrig’s Disease)

- degeneration and loss of motor neurons in the spinal chord, brainstem, and brain (CNS).

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2
Q

Who does ALS’s affect (4)?

A
  • avgerage onset 55 y/o (can occur at any age)
  • 20% more common in men than women
  • 5-10% of cases are inherited
  • large majority have no family history of disease
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3
Q

What are the early symptoms of ALS (7)?

A
  • painless, PROGRESSIVE MUSCLE WEAKNESS (most common)
  • tripping
  • dropping things
  • abnormal fatigue in arms and/or legs
  • slurred speech
  • muscle cramps and twitches
  • and/or uncontrollable periods of laughing or crying
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4
Q

Since ALS attacks only motor neurons, what is not affected (2)?

A
  • the 5 senses (sight, touch, hearing, taste, smell)

- for many people, muscles of eye’s and bladder

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5
Q

For most patients what is the prognosis with ALS?

A
  • for most 3-5 years after diagnosis

- death usual result of respiratory failure

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6
Q

What characteristic make for a better prognosis for patients with ALS?

A
  • if < 35-40 y/o have better 5 year survival rates

- if limb onset rather than bulbar (mouth and throat) onset

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7
Q

Signs and symptoms of ALS _____ _______ within a ______ before moving to other regions.

A

spread locally; region

regions include bulbar, cervical, thoracic, lumbosacral

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8
Q

Clinical presentation of muscle weakness with ALS (4)?

A
  • focal, asymetrical muscle weakness beginning in LE (feet), UE (hands), or bulbar muscles (face)
  • initially isolated muscles distally and progress proximal
  • cervical extensor weakness is typical
  • weakness leads to 2° impairments (decr ROM, subluxation, joint contractures, adhesive capsulitis)
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9
Q

Why does the clinical presentation of fatigue happen in ALS (3)?

A
  • as motor neurons die, remaining or sprouted neurons have to work harder
  • weak muscle have to work at a higher % of max strength to perform same activities
  • could also be from sleep disturbance, respiratory impairments, hypoxia, depression.
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10
Q

What other LMN signs can/will a patient have with ALS (3)?

A
  • hyporeflexia, decreased or absent reflexes, decreased tone or flaccidity
  • muscle cramping
  • fasciculations (random twitching seen through skin)
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11
Q

Are fasciculation a usual ‘initial’ symptom with ALS?

A
  • no, common but rarely an initial symptom
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12
Q

What UMN sign and impairments are seen with ALS (4)?

A
  • spasticity
  • hyperreflexia
  • clonus
  • babinksi or hoffman
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13
Q

What happens to UMN signs as ALS progresses?

A
  • may decrease
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14
Q

What bulbar impairments are seen with ALS (4)?

A
  • dysarthria (difficult speech)
  • dysphagia (difficult swallowing)
  • sialorrhea (excessive saliva and drooling)
  • pseudobulbar affect (poor/impaired emotional control)
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15
Q

What respiratory impairments are seen with ALS (6)?

A
  • loss of respiratory muscle strength
  • decreased vital capacity
  • early signs of fatigue, dyspnea with exertion, diff sleeping supine, walking at night, daytime sleepiness, morning headache d/t hypoxia
  • progressing to truncated speech, orthopnea, dyspnea at rest, paradoxical breathing, accessory muscle use, weak cough
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16
Q

If vital capacity reaches < 25-30% and the patient doesn’t do on a ventilator whats gonna happen?

A
  • CO2 retention will lead to acidosis, coma, and death d/t respiratory failure
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17
Q

If an ALS patient has no muscle support what are they at high risk of getting?

A
  • pneumonia
18
Q

What % of patient with ALS get cognitive impairments?

A
  • 35.6%
19
Q

What cognitive impairments are seen with ALS?

A
  • ALS associated frontotemporal dementia (FTD)

- patients with bulbar onset are more likely to have cognitive impairments

20
Q

How is ALS diagnosed?

A

The presence of:
- >/= 1 LMN sign (by clinical electrophysiological or neuropathological exam)
- >/= 1 UMN sign (by clinical exam)
- 1 region (progression within a region or to other regions of body)
The absence of:
- electrophysiological or neuropathological evidence of other disease
- neuroimaging evidence of other diseases.

21
Q

What does medical management of ALS consist of (2)?

A
  • symptomatic management (palliative care)

- only current drug approved is riluzole (Rilutek) and may extend life 2-3 months.

22
Q

Goals of medical management in ALS (7)?

A
  • inform patient/family of diagnosis and prognosis
  • diagnosis and cognitive concerns
  • drug therapies
  • multidisciplinary management and palliative care
  • manage communication problems (sign and symptoms list)
  • nutrition management PEG decisions (feeding tube)
  • respiration management and ventilation devices
23
Q

What ALS specific quality of life measure are there (5)?

A
  • ALSFRS (functional rating scale)
  • SF-36
  • SEIQoL-DW
  • sickness impact scale
  • ALSAQ-40 (assessment questionnaire)
24
Q

How often is an ALS patient evaluated by the entire clinic team?

A
  • every 6 months
25
Q

How often is an ALS patient seen by a health professional?

A
  • at least every 3 months
26
Q

What role does PT play in ALS (5)?

A
  • promote independence and maximize function
  • promote health and wellness (early and middle stages)
  • provide alternative means for carrying out functional activities (adaptive equip. and alternative methods)
  • minimize or preventing complications
  • provide education and psychological support
27
Q

Why do ALS patients present looking down or falling forward and what can be done for it (5)?

A
  • progressive cervical extensor weakness (overstretching posterior muscle/soft tissues)
  • can cause acute pain and anterior muscle shortening
  • some with compensate by increase lordosis when ambulating
  • for mild to moderate cases a soft foam collar
  • for moderate to severe cases a semirigid or rigid collar
28
Q

What are possible concerns with a semirigid or rigid collar (4)?

A
  • warmth
  • discomfort
  • pressure of trachea
  • feels confining
29
Q

What is the incidence of adhesive capsulitis with ALS?

A
  • 20%
30
Q

What factors can be causing shoulder pain for those with ALS (5)?

A
  • abnormal scapulohumeral rhythm due to spasticity/weakness
  • imbalance causing impingement
  • overuse of strong muscles
  • faulty resting position
  • GH subluxation 2° to weakness or a fall
31
Q

What PT treatments can be used to treat shoulder pain in an ALS patient (5)?

A
  • modalities
  • ROM exercises
  • passive stretching
  • joint mobs
  • edu on proper joint alignment and protection
32
Q

How can PT address LE weakness and gait impairments in patients with ALS (2)?

A
  • orthoses
  • assistive devices (to improve function, safety/decrease falls, decrease fatigue)
  • be sure to consider the weight of the device for future use
33
Q

What can help ALS patient with sit-to-stand (3)?

A
  • elevate chair or bed
  • seat lifter, UpLift Seat
  • train caregivers on assistance
34
Q

What can help ALS patient with transfers (4)?

A
  • sliding board
  • transfer/gait belt
  • hydraulic or mechanical lifts (easy pivot or hoyer lift)
  • extensive edu and training for caregivers on patient safety and protecting themselves from injury.
35
Q

Should ALS patient ever consider a power scooter?

A

H-E-double hockey sticks NO!

36
Q

What is important when helping a ALS patient with their mobility needs (4)?

A
  • power wheelchair must be tailored to current and potential future needs
  • custom to meet comfort needs
  • a loaner (power wheel chair) might be availalbe until custom one is received
  • must consider home accessibility and transportation when having a power wheel chair
37
Q

What psychosocial issues need to be taken into consideration with ALS (4)?

A
  • the diagnosis is devastating to patient and families so quality of life is quickly affected.
  • emotional responses are complex and may fluctuate much like the stages of grief.
  • help the team differentiate between normal grief and anxiety/depression.
38
Q

Summarize exercise and ALS (7)?

A
  • overuse weakness does not occur in muscle grades 3/5 or higher
  • moderate resistance can increase strength in muscle grades 3/5 or higher
  • strength gain are proportional to initial muscle strength
  • exercise may not improve the strength of muscles already weakened by ALS (especially if <3/5)
  • avoid heavy eccentric exercises
  • exercise may produce functional benefits
  • psychological benefits yet to be determined
39
Q

What exercise can safely be prescribed for ALS (3)?

A
  • general active ROM and stretching of affected joints
  • resistive strengthening exercises of unaffected muscles with low to moderate weights
  • aerobic activities such as swimming, walking, bicycling, at submaximal levels
40
Q

How do you write goals for ALS patient?

A
  • write goals to achieve in 1 or 2 sessions
41
Q

How soon do you want to about home accessibility?

A
  • any time after first evaluation (if appropriate)

- sooner the better

PT 942 Phys Rehab II (15 decks)

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