Term
| Your ALS eval will look like the eval of any other pt, but what might you be able to leave out of an ALS eval? Why? |
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Definition
| Sensation testing, because sensation isn't usually a Sx. |
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Term
| What do you want to assess in addition to your normal eval? How can you do this? |
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Definition
| Fatigue. Use the fatigue questionnaire, visual analogue scale, use of daily activity log, ADL indexes ie: Barrthe Questionnaire. |
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Term
| What's the problem w/ daily activity logs as a measure of function/fatigue? |
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Definition
| It's hard to get compliance - pts don't want to write down every single thing they do all day and how they feel when they do it. |
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Term
| What kind of info do ADL indexes provide you? |
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Definition
| An idea of what the pt is able to do independently in daily life. |
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Term
| What are your goals for the Tx of the ALS pt? (4) |
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Definition
| 1. Increase strength. 2. Maximize functional abilities. 3. Prevent contractures, respiratory infections, decubitus ulcers. 4. keep pt as comfortable as possible. |
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Term
| How can you help prevent respiratory infections? (5) |
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Definition
| 1. Deep breathing. 2. Positioning. 3. Coughing/clearing secretions. 4. suctioning. 5. Strengthening the accessory muscles if they can be used to breathe. |
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Term
| How many stages of disease are there for ALS? |
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Definition
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Term
| Describe the characteristics of stage I. |
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Definition
| Focal weakness; can perform life activities. Mild weakness, clumsiness. The pt is ambulatory and independent w/ ADLs. |
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Term
| What is the focus of Tx in Stage I? |
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Definition
| Patient education and secondary problems prevention. |
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Term
| How do you prevent secondary problems in stage I? (3) |
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Definition
| 1. Strengthen stronger muscles. 2. Avoid fatigue. 3. Active ROM of shoulder and ankle and neck to prevent contraction. |
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Term
| Describe the characteristics of Stage II. |
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Definition
| Independent w/ amb, moderate weakness in certain muscles. Muscle imbalances, decreased mobility and function, increased energy expenditure, but still ambulatory. |
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Term
| What are the stage II Tx strategies? |
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Definition
| 1. Orthoses 2. Decreased energy expenditure. 3. Gentle ROM/strengthing. 4. Strengthening for prevention of disuse atrophy. |
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Term
| What quality do you want to find in an orthosis for weakness affecting gait? |
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Definition
| Lightweight for minimal energy expenditure. |
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Term
| What are the stage III characteristics? |
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Definition
| Ambulatory, but w/ severe weakness in some muscles. Severe selective weakness in ankles, wrists, hands. Decreased independence w/ ADLs. Fatigue w/ long distance ambulation. Increased Respiratory effort. |
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Term
| What are the stage III Tx strategies? (4) |
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Definition
| Home equipment (assistive devices, orthoses), Strengthen respiratory muscles. Continue stage II program as tolerated to prevent fatigue. Family Training. |
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Term
| What will the family training consist of in stage III? (5) |
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Definition
| Equipment training, expectations, how to assist w/ mobility/ambulation, recommend additional counseling, stretching assistance. |
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Term
| Describe the characteristics of stage IV. |
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Definition
| Pt is primarily a w/c user, arms not as affected as LEs. Shoulder pain/edema, LE weakness, may be able to perform some ADLs. |
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Term
| What are the things to consider when prescribing a w/c? |
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Definition
| They won't be able to push a manual chair for long, probably. So you want to look at power mobility. But a lot of it depends on finances. Power chair increases independence and decreases load on caregiver. But pt won't live long, so it might not be worth the $. The decision is usually made by the funding source. |
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Term
| What will Tx of stage IV consist of? |
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Definition
| Equipment, skin care, ROM/stretching, continued family ed. (transfers in/out of chair, chair ed., home eval), encourage contractions of all muscles as much as possible. |
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Term
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Definition
| Full-time w/c user, dependent for care. UE weakness=mod to severe, LE weakness=severe. Decreased independence in all ADLs. Skin problems. Increased pain. |
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Term
| What are the stage V Tx strategies? |
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Definition
| Caregiver instruction, Frequent repositioning in bed, Continued ROM for mobility, modalities for pain, specilized equipment (hoyer, w/c cushion, commode, bed downstairs), respiratory care. |
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Term
| Describe the stage VI pt. |
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Definition
| Final stage - primarily in bed, dependent for all activity. |
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Term
| What are the Tx strategies in stage VI? |
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Definition
| Primarily comfort care. Proper mattress, turning schedule, assistive coughing, pain management, ventilator use. |
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Term
| What are the goals for therapeutic exercise? (4) |
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Definition
| 1. increase strength. 2. prevent disuse atrophy. 3. maintain ROM. 4. Improve respiratory status. |
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Term
| What kinds of modailities do you want to use? What should you avoid? |
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Definition
| Use: Thermal agents for pain or prior to ROM, TENS, joint mobs, Massage. Don't use: cold! It will increase spasticity. |
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Term
| What kind of splinting will you be looking at? |
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Definition
| 1. volar cockup. 2. dynamic finger extension. 3. Resting hand splint. 4. anti claw. |
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Term
| What do you want to do to promote respiratory function? (5) |
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Definition
| 1. diaphragmatic strenghthening. 2. inspirometer/triflow. 3. preserve chest mobility. 4. coughing. 5. postural drainage. |
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