OT with Amyotrophic Lateral Sclerosis: A Major Role!

Waad Aljurayed/ Asma Almutairi/ Manar Almutairi

King Saud bin Abdulaziz University for Health Sciences

Introduction
What is ALS?

Amyotrophic Lateral Sclerosis (ALS) is a disease

that results in a gradual loss of skeletal muscles in
response to the death of motor neurons. It is
characterised by symptoms that include deterioration
of the muscles, combined with persisting weakness,
spasticity, and fatigue. According to ALS
Association (2010), two people out of 100,000 are
diagnosed with it each year. The average life
expectancy of people with ALS after being
diagnosed is three years, yet a low percentage might
live for more than ten years.

Occupational Therapy Intervention with ALS

Phase I: mild, moderate, to severe selective weakness in the ankles, wrists, and hands / independent to moderately decreased independence in ADLs
Intervention focus on performance areas of occupation:
-Prevent disuse atrophy and depression by continuing a normal activities or
increase it
-Provide to the client a psychologic support as needed
-Prescribe a manual or power wheelchair with modifications and help the patient
prioritize activities and provide work simplification.
-Explore alternative activities when loss of employment or other activities
-Start discussing the need for home modifications, such as installing ramps or
moving the bedroom to the lowest floor
-Provide education for energy conservation and safety

Intervention with focus on client factors:

-Begin range of motion program & strengthening program of gentle resistance
exercise
-Monitor for overwork fatigue when consider orthotic support such as wrist or
thumb splints and AFOs strengthening of muscles with MMT grades above F+
(3+)
-Encourage deep-breathing exercises, chest stretching, and postural drainage if
needed
-Use adaptive equipment to facilitate ADLs

Phase II: Hanging-arm syndrome, severe lower extremity. Moderate to severe upper extremity weakness / increasingly dependent in ADLs

SOURCE: University of Michigan Health System, Internet Money & Business Development and U.S. Patent Office.
Retrieved from: http://archive.freep.com/interactive/article/20120805/NEWS06/120804036/Graphic-What-ALSAmyotrophic-Lateral-Sclerosis-

A significant number of researches agree that

Occupational Therapy (OT) can prolong the life of
ALS patients and considerably improve its quality.
OTs provide re-evaluations as the disease progress to
different stages; the interventions vary depending on
the patients needs and desire to be independent.

Occupational Therapy Role with ALS

Occupational Therapy Evaluation

Occupational therapists have their own distinct

assessments of the disease. Patients are assessed
in the beginning and throughout the course of the
disease in order to be re-educated about how to
adapt to the degenerative functional changes.

RESEARCH POSTER PRESENTATION DESIGN 2015

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RESEARCH POSTER PRESENTATION DESIGN 2015

Intervention focus on performance areas of occupation:

-Evaluate the need for arm slings, overhead slings, and mobile arm supports for
eating, typing, and page turning
-Consider negotiating roles with significant others while Helping the patient to
prioritize activities
-Assist with the patients ability to participate in closure activities, such as writing
letters ,completing a life history
-Train family members so that they learn proper transfer, positioning principles,
and turning techniques
-Adapt the wheelchair for a respiratory unit if needed to allow continued
community access

Intervention with focus on client factors:

-Instruct the family and patient in skin inspection techniques and in the use of an
electric hospital bed and antipressure device
-Adapt the wheelchair for a respiratory unit if needed; reassess the adequacy of
the wheelchair cushion for relief of pressure
-Provide arm troughs or a wheelchair lap tray for wheelchair positioning and wrist
cock-up splints for full resting If arm supports are not used; hand splints may be
needed for positioning
-Provide pain and spasm management
-Antiedema measures
-Active assisted or passive range-of-motion exercises for the weak joints;

Phase III: Dependent, with all positioning in a bed or wheelchair completely dependent in ADLs Extreme fatigue
Intervention focus on performance areas of occupation:
Intervention with focus on client factors:
-Eating: evaluate for dysphagia, and recommend an appropriate diet; the therapist -Continue with passive range-ofmotion exercises for all joints
may recommend tube feedings if the patient is at high risk for aspiration and for -Provide sensory stimulation with massage and skin care
handling secretions and preventing aspiration therapist recommend a suction
-In addition to speech therapy, an augmentative speech devices may be
machine
recommended

OT in Multidisciplinary Team

Occupational therapy is one of the discipline that

has a significant role with ALS patients, the
practitioners work to optimize the quality of their
life, and help them to participate in the activities and
roles that is important for them. Studies show that

patients who participate with multidisciplinary

team rate for 30% longer survival.
Palliative Care

. Occupation therapy practitioners work to:

1- decrease stress & pain in patients and families.
2- help them to live actively and do a meaningful
activities until their death.
3- support the families by teaching them how to
cope with this disease.
4- responsible to make a discussion about the end
life & explain the dying as a normal process of life.
The best time to participate in palliative care is at
diagnosis.
Electric Stimulation

One of the preparatory methods used for

occupational performance is electric stimulation. It
works to stimulate the nerve in the upper and lower
extremities. It might help ALS patients by improve
bilateral hand function and knee extension.

Conclusion
Occupational therapy practitioners need to be
confident in their skills for helping clients
functionally navigate the psychosocial issues
surrounding end-of-life decisions, have a thorough
understanding of splinting concepts, and the value
and drawbacks of using various splints with people
with ALS, and must understand positioning and
pressure ulcer prevention and how to incorporate
these concepts into ADL routines.
Arbesman, M., & Sheard, K. (2014). Systematic review of the effectiveness of occupational therapyrelated interventions for people with
amyotrophic lateral sclerosis. American Journal of Occupational Therapy, 68(1), 20-26.
Pendleton, H. M., & Schultz-Krohn, W. (2013). Pedretti's occupational therapy: practice skills for physical dysfunction. Elsevier Health Sciences.