• Upper motor neurons: causes spasticity, slow movements, poor balance and incoordination

• Lower motor neurons: causes muscle weakness, atrophy, and twitching

  
  

Eventually, motor neurons deteriorate, resulting in their death. The brain can't send signals to muscles --> muscles won't be able to contract. As a result, muscles will shrink and weaken.

Diagnosis is mainly based on:

• History and presence of motor neuron S&S

• Along with other tests to rule out other neurological diseases:

  • Nerve Conduction Study (NCS)

  • Magnetic Resonance Imaging (MRI)

  • Lab tests

  • Electromyogram (EMG)

  • Muscle or nerve biopsy

  • Spinal tap

• Muscle weakness in distal upper and lower extremities

• Spasticity

• Slurred speech

• Difficulty swallowing

• Fatigue

• Dropping things

• Tripping and falling

• Uncontrollable periods of laughing or crying

Advanced Symptoms: (Kiernan, M. C. et al., 2011)

• Inability to walk

• Muscle atrophy spread to other body parts

• Dysphagia

• Drooling

• Dysarthria

• Dyspnea

• Death

  
  

*ALS does NOT affect intelligence (University of Rochester Medical Center, n.d.)

*Respiratory muscle dysfunction = MAIN CAUSE OF DEATH

2 types of ALS:

1. Sporadic ALS:

   • ~90% or more are sporadic

   • Occurs randomly

   • No associated risk factors

   • No genetic component

2. Familial ALS:

   • 5-10% of cases are familial

   • Inherited from parents

• Managing symptoms

• Preventing complications

• Maintaining QOL

Treatments:

• Heat or whirlpool therapy

• Exercise (in moderation)

• Medications

  • Eg. Riluzole --> ONLY disease-modifying drug

• Physical Therapy:

  • Low-impact aerobic exercise

  • ROM & stretching

• Nutritional Support:

  • Smaller meals + easier to swallow

  • Feeding tube

• Respiratory Support:

  • Noninvasive ventilation (NIV) (Kiernan, M. C. et al., 2011)

  • Mechanical cough assist devices

  • Tracheostomy (aka breathing tube)

Prognosis:

• Most people live ~3-5 years after onset of symptoms

• Focus - on maintaining physical fitness, mobility and independence

• Create exercise programs

• Patient and family education

• Electrical stimulation, thermals, ultrasound

PTA:

• Show and explain exercise programs for patient

• Patient and family education

• Support and motivation

• Thermals and ultrasound

OT: (Lewis & Rushanan, 2007)

• Focus - maintain independence and quality of life

• Teach compensatory techniques (i.e. adaptive equipment)

• Patient and family education

• Energy conservation techniques

OTA:

• Teaching adaptive device use

• Patient and family education

• Provide motivation and encouragement

• Energy conservation

Dietician: (Parrish, 2022)

• Focus - preventing malnutrition

SLP:

• Focus - speech and swallowing issues