Assessment &
Intervention of
Amyotrophic
Lateral Sclerosis
(ALS)
OT 510/515
Rachel Rombalski
Amy Londry
Rachel Csatari
Alyssa Kolanowski
Introduction
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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)
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A group of progressive, degenerative neuromuscular diseases.
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2 types: Familial ALS and Sporadic ALS
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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.
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Destruction of motor neurons (upper and lower) within the spinal
cord, brain stem, and motor cortex.
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
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Stage I
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Stage II
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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
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Severe, selective weakness in ankles, wrists, and hands. Moderately decreased
independence in ADLs. Tendency to become easily fatigued with long-distance
ambulation.
Stage IV
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Moderate, selective weakness, slightly decreased independence in ADLs
Stage III
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Mild weakness, clumsiness, ambulatory, independent with ADLs
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
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Dependent, with all positioning in bed and wheelchair. Completely dependent
in ADLs. Extreme fatigue.
Case Study: Roberto
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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
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Willing to use adaptive equipment, but never wants
to be dependent with feeding
Currently receiving outpatient rehab with an OT
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Client wants to continue doing these activities as long as possible
OT is using a completely client centered approach with the
rehabilitative fame of reference
Things noted in occupational profile:
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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
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ADLs
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IADLs
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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
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Bathing, dressing, eating, feeding, functional mobility,
personal device care, hygiene/grooming
Participation in
Social Participation
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Family and friends
Role of Occupational Therapy
in Treating ALS
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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
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The need for:
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Adapted equipment
Built up eating utensils
 Built up golf club
 Shower stool
 Handrails
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Frequent rest breaks
Fatigue
Functional mobility
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Wheelchair
Rehabilitative Frame of
Reference
 ALS
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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
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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
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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.
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Lewis, M. & Rushanan, S. (2007). The role of physical therapy and
occupational therapy in the treatment of amyotrophic lateral sclerosis.
NeuroRehabilitation, 22, 451-461.
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Pendleton, H. M. & Schultz-Krohn, W. (2006). Pedretti’s occupational
therapy: Practice skills for physical dysfunction. St. Louis Missouri: Mosby
Elsevier.
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MDA ALS Division (May, 2009). Everyday Life With ALS: A Practical
Guide. Retrieved from http://www.als-mda.org/