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ALS : Occupational Therapy

[Amyotrophic Lateral Sclerosis]

Help Educate your Client on ALS

Lou Gehrig’s disease (professional baseball player died from the dx in 1941)

Most common motor neuron disease with an incidence rate of 2 per 100,000 people[1]

People are usually diagnosed late due to hesitancy in going to neurologist 

Men are affected more than women (A story of a woman with ALS)

Cause unknown (combination of genetic, viral, retroviral, autoimmune, neurotoxic factors

 

Gross nervous system impact – it is labeled for which system it impacts first (3 types)

  • Primary Lateral Sclerosis (slower progression)

upper motor neuron

increased reflexes and increased muscle tone

Decreased balance and movement

  • Progressive muscular atrophy or lower predominant ALS

lower motor neuron

atrophy, weakness, and decreased reflexes

  • Bulbar Palsy or Bulbar Predominant ALS

Speech and swallowing deficits first

 

Six Stages [2]

 

Stage 1: The person can walk, is independent with ADLs, and has some weakness

Stage 2: The person can walk and has moderate weakness

Stage 3: The person can walk but has severe weakness

Stage 4: The person requires a wheelchair for mobility, needs some assistance with ADLs, and has severe weakness in the legs

Stage 5: The person requires a wheelchair for mobility, is dependent for ADLs, and has a severe weakness in the arms and legs

Stage 6: The person is confined to bed and dependent for ADLs and most self-care tasks

Symptoms and Clinical Presentation of ALS

Symptoms and Clinical Presentation

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Evaluations and Progress Notes for Amyotrophic Lateral Sclerosis [ALS]

(S) Subjective

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(O) Objective

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(A) Assessment

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(P) Plan

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Interdisciplinary Approach for ALS

Interdisciplinary Approach for ALS

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General Treatment Ideas for Parkinson’s Disease

Person

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Environment

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Occupation

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Research Approach Ideas for ALS 

Research Approach Ideas

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References

References
  • Arbesman, M. and K. Sheard, Systematic review of the effectiveness of occupational therapy-related interventions for people with amyotrophic lateral sclerosis. The American journal of occupational therapy, 2014. 68(1): p. 20-26.
  • Forwell, S.J., Occupational therapy practice guidelines for adults with neurodegenerative diseases / Susan J. Forwell. AOTA practice guidelines series. 2006, Bethesda, MD: American Occupational Therapy Association.
  • Lakerveld, J., B. Kotchoubey, and A. Kübler, Cognitive function in patients with late stage amyotrophic lateral sclerosis. Journal of neurology, neurosurgery and psychiatry, 2008. 79(1): p. 25-29.
  • Mahle, A.J. and A.L. Ward, Adult Physical Conditions: Intervention Strategies for Occupational Therapy Assistants. 2019, Philadelphia, PA: F.A.Davis. 1057.
  • Lunetta, C., et al., Strictly monitored exercise programs reduce motor deterioration in ALS: preliminary results of a randomized controlled trial. Journal of neurology, 2016. 263(1): p. 52-60.
  • Dal Bello-Haas, V., et al., A randomized controlled trial of resistance exercise in individuals with ALS. Neurology, 2007. 68(23): p. 2003-2007.
  • Braga, A.C.M., et al., The Role of Moderate Aerobic Exercise as Determined by Cardiopulmonary Exercise Testing in ALS. Neurology research international, 2018. 2018: p. 8218697-10.
  • Jones, K.E., et al., Intentions of Canadian health professionals towards recommending exercise for people living with ALS. BMC neurology, 2019. 19(1): p. 204-204.
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