ALS PT Management Extras

Question 1

4 things to consider developing plan of care in patients with ALS?

Answer 1

1. Rate of disease progression
2. Disease stage
3. extent & area involvement
4. regular re-examination

Question 2

ALS

What is our focus with ALS outcome measures?

Answer 2

1. Quality of life
2. Function & Participation

Question 3

What should we NOT focus our outcomes on?

Answer 3

Impairments

Question 4

🚩

Disease-specific measures for patients with ALS:

Answer 4

1. ALS Functional Rating Scale
2. Appel ALS Scale
3. Norris Scale
4. ALSAQ-40: ALS-specific quality of life assessment

Question 5

The revised ALS Functional Rating Scale includes:

Answer 5

Additional respiratory items

(Able to predict 9-month survival)

Question 6

2 primary goals due to the progressive condition of ALS:

Answer 6

1. Maintain maximal independence in daily life
2. Maintain Positive quality of life (as long as possible)

Question 7

Special Therapeutic Considerations in ALS patients:

Answer 7

• Prevention of disuse atrophy
• Prevention of overuse injury

Question 8

Avoid ____________ to prevent overuse injury

Answer 8

heavy ECCENTRIC exercise

Question 9

ALS resistive exercises focus on:

Answer 9

• concentric over eccentric -only resistance to muscles >3/5

Question 10

Participation level (such as quality of life) may be
more positively impacted by physical therapy than
impairment and activity levels due to

Answer 10

the progressive nature of ALS

Question 11

No ALS-specific measures for balance or gait but
some studies have reported reliability of

Answer 11

general measures (TUG, Tinetti) in an ALS population

Question 12

True or false: strength training of muscles with less than 10% of normal strength is ineffective in ALS patients

Answer 12

true

Question 13

Strengthening exercises ONLY in muscles that have anti-gravity strength of  more than

Answer 13

3/5

Moderate resistance and intensity: 1-2 sets of 8-12 reps OR 3 sets of 5 reps

Question 14

ALS Intervention: Early Stage

Answer 14

• Restorative/Preventative:
  
  • Strengthening & endurance
  • AROM/AAROM/stretching
• Compensatory:
  
  • Adaptive devices

Question 15

Intervention: Late Stage

Answer 15

•  Preventative:
  
  • PROM
  • Pulmonary care
  • Hospital bed
  • Pressure relief equipment
  • Skin care/hygiene
• Compensatory:
  
  • Caregiver education re; transfers, positioning, skin care.
  • Mechanical lift

Question 16

ALS Intervention: Middle Stage

Answer 16

• Compensatory:
  
  • ​​Assistive devices, caregiver education
• Preventative:
  
  • ROM, AAROM, PAROM
  • Strengthening & endurance ex.
  • Pressure relief equipment