• Selegiline will be used first then changed to Levodopa as the disease progresses. Levodopa will block the breakdown of DA and slow the disease progression

• Anticholinergics help reduce tremors, and Symmetrel helps with bradykinesia, rigidity, and motor fluctuations.

Potential Complications:

• Bradykinesia, rigidity, tremor, and postural instability.

• Present with a shuffling gait, punctuated short steps, and increased speed (festination).

• Rigidity will occur in the trunk and extremities, and they will lose their ability to swing their arms while walking.

• Postural instability will limit their participation in life and increase their risk of falling.

• Easily fatigued and can exhibit dementia and intellectual changes that can lead to depression.

• Gait initiation and straight walking: pt will ambulate with walking poles to elicit proper gait speed. Markers are placed on the floor to ensure they are ambulating with proper gait mechanics and the use of the mirror is to ensure proper trunk engagement during ambulation.

• Pt. will ambulate 50 feet forward and backward x3.

Intervention 2:

• Farmer carries to strengthen postural musculature for proper trunk control and postural stability.

• 50 feet x 4 with 10lb dumbbells

• The Rocky Mountain Chapter raises money to help aid in medical research to help with the progression of the disease and the possibility of a cure.

https://www.parkinson.org/RockyMountain?_gl=1*1lmreyc*_gcl_au*MTk1Mzk5ODY3NS4xNzQwNTA5MzIw&_ga=2.123049931.1750757739.1740509320-1468153668.1740509320

• IVIG (infusion of intravenous immunoglobulins) is the preferred treatment.

• Treatment may need to be repeated

• 20% of patients treated unable to ambulate after six months

• Three stages

  • acute

  • plateau

  • recovery

• 25% of patients may require mechanical ventilation (days to months)

Physical Therapy Management

• Acute phase

  • minimize signs and symptoms

  • support pulmonary function

  • prevent skin breakdown and contracture formation

  • managing pain

  • Only exercises without pain or excessive fatigue

• Plateau phase

  • acclamation to upright posture

  • maintenance of ROM

  • improvement in pulmonary function

  • avoidance of fatigue and overexertion

• Recovery phase

  • strengthening/maximizing functional abilities

  • goals from acute and plateau phases

  • exercise needs to be dosed appropriately to minimize muscle damage

• Pharmaceuticals: Riluzole is the only medication approved for ALS. Other medications can assist with muscle cramping, spasticity, sialorrhea, and depression.

• Speech therapy to address swallowing difficulties.

• Nutritionist and dietitian for feeding.

• Feeding tube or endoscopic gastrostomy tube

• Ventilator

Potential Complications:

• They will have limb loss, bulbar loss, asymmetric weakness in the arm/leg, difficulty with swallowing and speaking, twitching, muscle cramps, weakness, atrophy, fatigue, and loss of cranial nerves.

• Early intervention can use the benefits of aquatic therapy to reduce stress on the joints, maintain motion, and assist with balance and coordination.

• Pt will ambulate in the shallow end of the water where the water is at 50% weight-bearing with standing marches and leg lifts for 30 seconds x3.

Intervention 2:

• Seated balance on the plinth with perturbations in every direction to address core stability and seated posture for 15 seconds x 3

• Easily fatigued

• Side effects of Riluzole can cause breathing problems, headaches, fatigue, and diarrhea

• Therapy should take place a few hours after medication is delivered

• May not feel up to therapy due to depression or increase in symptoms that day

• Cortisone and corticosteroid side effects: muscle weakness, bone loss, bruising

• Provigil side effects: nausea, anxiety, headache, nervousness

• Tegretol side effects: fatal allergic reactions, aplastic anemia, blurred or double vision, and continuous back-and-forth eye movements.

Physical Therapy management:

1. minimize progression

2. maintain functional independence

3. prevent secondary complications

4. maintain respiratory function

5. conserve energy/manage fatigue

6. patient and family education

Complications in PT Treatment:

1. fatigue/ exercise intolerance

2. fear of movement

3. Heat intolerance

https://www.als.org/support/support-groups?utm_source=google&utm_medium=paidsearch&utm_campaign=grant&utm_content=eg-pro&s_src=paidsearch&s_subsrc=google-508&gad_source=1&gclid=EAIaIQobChMIqqCQscTfiwMVIDWtBh3sDy2tEAAYASAAEgKyz_D_BwE

• Medications are not proven to be effective and the best way to manage this disorder is through individualized muscle training programs and physical activity levels.

• IVIG could potentially help with pain but it is not approved to be used.

Potential Complications:

• Easily fatigued

• Overuse can lead to increased muscular weakness

• Impaired balance can lead to falls

• May need an assistive device and be fitted properly for one

• Pain is a huge factor when it comes to therapy

• Unstable joints

• Increased risk of depression

• Cold intolerance

• Stationary bicycling for 15 minutes to reach the target heart rate, avoid joint trauma, and target the strongest muscle groups in the LE (quads).

Intervention 2:

• short arc quads 10x3 with no weight to decrease joint stress and progress to long arcs when quadriceps have the strength to progress without causing joint trauma.

Suzanne "Tink" Martin, Kessler M. Neurologic Interventions for Physical Therapy. Elsevier Saunders; 2016.

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