by Danielle Leclerc, PT, April 4, 2016
Amyotrophic Lateral Sclerosis (ALS) or Lou Gehrig's disease is a neurodegenerative disease that causes rapidly progressive muscle weakness. During the disease process the individual may have difficulty with maintaining an upright posture, walking, transitioning for transfers and bed mobility and completing self care and feeding activities independently. They may have questions about the disease process or about exercises as well as safety concerns.
A multidisciplinary approach is very important in covering all the aspects of the individual's life including medical, emotional/psychological and physical. Physical Therapy plays a critical role in educating the individual and family on exercise, functional mobility, stretching, balance, fall prevention and equipment needs. Each session with the Physical Therapist can be used to discuss guidelines and frequent modifications with the exercise program.
The settings for Physical Therapy intervention can include the ALS clinic, Outpatient clinic and Home Health as the individual's condition deteriorates. However the goal is always the same; to provide the family and individual with the skilled guidance to maintain a safe and functional environment to provide the best quality of life.
During the early phase of the disease the Physical Therapist will perform a comprehensive evaluation to determine the individual's range of motion, strength, posture, gait, endurance and functional mobility. At this early phase it is crucial to have a home assessment completed so a plan can be set for possible home modifications and equipment needs for the future. Addressing these issues early will decrease the stress on the family and decrease the risk that the individual will not have the proper environment to remain safely at home as the disease progresses.
Early intervention on diaphragmatic breathing and passive range of motion exercises for the limbs are essential so the individual and family have the time to master these activities. The Physical Therapist will develop a program appropriate for the individual's functional level and will continue to monitor and modify the activities during the course of the treatment. Initially balance, gait, conditioning and strengthening activities will be suggested to suite the individual's needs. As the disease process progresses, the focus will be more on addressing the health and strength of the uninvolved muscles without over working the involved muscles, range of motion exercises to provide proper joint mobility for self care and decrease the risk of contractures of the limbs, education on proper pressure relief and positioning techniques to decrease the risk of pressure sores, equipment needs to assist with posture (such as a neck brace), a stair lift or a transport/power wheel chair as their functional level declines to ensure they remain mobile and safe.
The changes in physical function are part of the ALS disease process. Physical Therapy can't change the disease process itself but it can reduce the risk of falls and injury and work with the family and individual on providing the proper guidance to maximize safety.