Assessment & Intervention of Amyotrophic Lateral Sclerosis (ALS) - PowerPoint Presentation

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Assessment & Intervention of Amyotrophic Lateral Sclerosis (ALS)

OT 510/515

Rachel

Rombalski

Amy

Londry

Rachel

Csatari

Alyssa

Kolanowski

Introduction

Brief overview of ALS

Stages of ALS

Case Study:

Roberto

Areas of Occupation

Affected

Role of Occupational Therapy in Treating

ALS

Assessment

Protocol

Expected Assessment

Results

Rehabilitative Frame of

Reference

Client-Centered Intervention

Amyotropic Lateral Sclerosis (ALS) (Lou Gehrig’s Disease)

A group of progressive, degenerative neuromuscular diseases

.

Destruction of motor neurons (upper and lower) within the spinal cord, brain stem, and motor cortex.

2 types: Familial ALS and

Sporadic ALS

Progressive bulbar palsy,

Progressive spinal muscular atrophy

, and Primary lateral sclerosis

Focal weakness beginning in arm, leg, and bulbar muscles

.

The individual may trip or drop things, may have slurred speech, abnormal fatigue, and uncontrollable periods of laughing or crying

.

As the disease progresses there is noted muscle atrophy, weight loss, spasticity, muscle cramping, and

fasciculations

(twitching of the muscle fascicles at rest).

**Does not affect cognition, but overall prognosis is difficult to predict because it varies from person to person.

Stages of ALS

Stage I

Mild weakness, clumsiness, ambulatory, independent with ADLs

Stage II

Moderate, selective weakness, slightly decreased independence in ADLs

Stage III

Severe, selective weakness in ankles, wrists, and hands. Moderately decreased independence in ADLs. Tendency to become easily fatigued with long-distance ambulation.

Stage IV

Hanging-arm syndrome with should pain and sometimes edema in the hand. Wheelchair dependent. Severe lower extremity weakness. Able to perform some ADLs, but fatigues easily.

Stage V

Severe lower extremity weakness. Moderate to severe upper extremity weakness. Wheelchair dependent. Increasingly dependent in ADLs. At risk for skin breakdown caused by poor mobility.

Stage VI

Dependent, with all positioning in bed and wheelchair. Completely dependent in ADLs. Extreme fatigue.

Case Study: Roberto

60 y/o married male, diagnosed with SALS 5 months ago, currently in stage II

Golfer, plays with grandchildren, cooking, takes trips, breakfast club with friends

Client wants to continue doing these activities as long as possible

Willing to use adaptive equipment, but never wants to be dependent with feeding

Currently receiving outpatient rehab with an OT

OT is using a completely client centered approach with the rehabilitative fame of reference

Things noted in occupational profile:

Abnormal fatigue

Uncontrollable periods of laughing or crying

Muscle weakness in arms and legs

Has trouble keeping balance in his life between activities

He “doesn’t know where his day goes”

Areas of Occupation Affected

ADLs

Bathing, dressing, eating, feeding, functional mobility, personal device care,

hygiene/grooming

IADLs

Care of others, care of pets, community mobility, health management and maintenance, home establishment and management, meal prep and clean up, shopping

Rest and Sleep

Leisure

Participation in

Social Participation

Family and friends

Role of Occupational Therapy in Treating ALS

Maximize ADL and IADL independence

Equipment and Modifications

Educating patient and family

Prescribing appropriate exercise, ROM, MMT

Preventing complications of immobility

Eliminating or preventing pain

Energy conservation

Lewis, M. &

Rushanan

, S. (2007). The role of physical therapy

and

occupational

therapy in the treatment of amyotrophic

lateral

sclerosis

.

NeuroRehabilitation

, 22,

451-461.

Assessment Protocol

**Interview + Occupational Profile + Skilled Observation of Functional Tasks

FIM

Canadian Occupational Performance Measure (COPM

)

Klein-Bell Activities of Daily Living Scale

Scoreable

Self-Care Evaluation

Self-Identification Goals Assessment (SIGA)

Expected Assessment Results

The need for:

A

dapted equipment

Built up eating utensils

Built up golf club

Shower stool

Handrails

Frequent rest breaks

Fatigue

Functional mobility

Wheelchair

Rehabilitative Frame of Reference

ALS is a degenerative disease

80% of individuals with ALS die within the first 3-5 years of

diagnosis

OT’s maximize independence and will focus on the here and now

Compensatory methods and adaptive equipment

Client-Centered Intervention

Stretching/Strengthening/ROM

Environmental modifications

Energy conservation

Assistive technology/Adaptive

equipment

Wheelchair assignment

Lewis, M. &

Rushanan

, S. (2007). The role of physical therapy

and

occupational

therapy in the treatment of amyotrophic

lateral

sclerosis

.

NeuroRehabilitation

, 22,

451-461.

Conclusion

ALS is a progressive degenerative disease

Although more research is needed, it is evident that occupational therapy intervention is beneficial in managing the symptoms of ALS.

The main goal of OT intervention for a client with ALS is to enhance the quality of his/her life.

References

Cup, E. H. C.,

Pieterse

, A. J.,

Knuijt

, S., Hendricks, H. T., Van

Engelen

, B. G. M.,

Oostendorp

, R. A. B., & Van

Der

Wilt, G. J. (2006). Referral of patients with neuromuscular disease to occupational therapy, physical therapy and

speechtherapy

: Usual practice versus multidisciplinary advice.

Disability and Rehabilitation, 29

(9), 717-726

.

Lewis, M. &

Rushanan

, S. (2007). The role of physical therapy and occupational therapy in the treatment of amyotrophic lateral sclerosis.

NeuroRehabilitation

, 22,

451-461

.

Pendleton, H. M. & Schultz-

Krohn, W. (2006). Pedretti’s occupational therapy: Practice skills for physical dysfunction. St. Louis Missouri: Mosby Elsevier.MDA ALS Division (May, 2009). Everyday Life With ALS: A Practical Guide. Retrieved from http://www.als-mda.org/