12017783
| Question | Answer |
| Neuropathology review: Areas involved in ALS | Cell bodies of motor neuron (both UMN and LMN) aka cortical and anterior horn and CN motor nuclei |
| Cause of ALS? | Idiopathic. |
| Classic presentations of ALS? | Both UMN and LMN signs |
| Location of symptoms at spinal onset of ALS | distal/proximal limb |
| Key differential diagnosis questions during subjective exam | 1. bowel/bladder issues? 2. sensory changes? 3. cognitive changes? |
| T/F: If the patient has sensory changes and/or cognitive changes, he/she is likely ALS. | F. NOT LIKELY. |
| To determine the type of onset of ALS, what do we ask the patient? | Location of onset (spinal v.s. bulbar) |
| What are your expected results for ALS patients for: 1. MMT 2. reflexes 3. sensation 4. bowel/bladder changes 5. fasciculations | 1. MMT: generalized weakness 2. reflexes: some hyper, some absent 3. sensation: normal 4. bowel/bladder changes: no 5. fasciculations: mild to significant fasciculations on affected muscles |
| What are the effects of exercise on ALS patients? | 1. increase in function (both aerobic and strength) 2. not much improvement in strength 3. no adverse event reported 4. better QoL |
| What MMT grade suggests compensation for a muscle group? | <3 (cannot resist gravity) |
| What are some key points of patient education? | 1. fatigue management 2. prognosis and compensatory technique 3. |
| What is the main precaution when treating ALS patients? | AVOID OVERWORK! |
| T/F: exercise in partially denervated muscle can further weaken the muscle rather than strength improvement. | T. |
| What is the recommended intensity for muscle training in ALS patients? | Moderate (50 - 70 of MVC) |
| T/F: the therapist should be the one deciding how many reps and sets an exercise should reach. | F. Patient monitor their symptoms via self -report (RPE) |
| T/F: At the mid stage of ALS, therapy should be focusing on compensation rather than recovery. | T. |
| recovery technique for early stage ALS | - moderate intensity endurance and resistance exercises |
| Compensation technique at early stage ALS | - energy conservation - pacing, bracing, adaptive equipment |
| Prevention technique at early stage ALS | - reduce fall risk |
| Compensation technique at mid-stage ALS | - caregiver training (transfers) - assistive devices - wheelchair assessment |
| Prevention technique for mid-stage ALS | - stretching - edema management - pain management |
| Compensation technique at mid-stage ALS | - continued caregiver training - further wheelchair assessment and adjustment |
| Prevention technique for late-stage ALS | - pressure ulcer management |
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