Amyotrophic Lateral Sclerosis

Question 1

Etiology

Answer 1

Lou Gehrig’s: progressing degeneration of the motor neurons in the CNS and PNS in which the neurons are replaced by scar tissue and results in muscle atrophy

Question 2

Signs and Symptoms

Answer 2

Progressive and move distal to proximal and depend on part of nervous system that is affected. Include weakness of small muscles of the hands or asymmetrical foot drop initially. Range of symptoms include distal muscle weakness, atrophy, cramping and twitching, spasticity, hyperreactive reflexes, dysphagia, dysarthria,

Six Stages

1. can walk, independent with ADLs, some weakness
2. can walk and has moderate weakness
3. can walk but has severe weakness
4. requires a WC and needs some assistance with ADLs, severe weakness in legs
5. WC, dependent for ADLs, severe weakness in arms and legs
6. confined to bed and dependent for all ALDs

Question 3

DIagnosis

Answer 3

physician or neurologist review, electromyogram results, other test to rule out other factors

Question 4

Prognosis

Answer 4

often progresses rapidly with a range of 1-5 years. Death usually caused by respiratory failure

Question 5

Team Management

Answer 5

Medications are for symptom management; 
Surgical options to help symptoms
PT
SLP
Respiratory Therapist
Palliative Care

Question 6

OT evaluation

Answer 6

Obtain specific level of function and client priority. Goals focus on minimizing symptoms for occupational performance.
ALS funcitonal rating scale
purdue pegboard
multidimensional fatigue inventory
dysphagia screening
Home Evaluation for safety and functional use

Question 7

OT intervention

Answer 7

should be compensatory and preventing secondary complications
Environmental intervention, positioning, transfers, communication devices, dysphagia, exercises to increase strength and preserve ROM however with careful consideration to decrease/eliminate overexertion