SPECIAL POPULATIONS
Amyotrophic Lateral Sclerosis (ALS)
ALS, commonly known as Lou Gehrig's disease, is a terminal, progressive disease that affects both the upper and lower motor neurons. The loss of lower motor neurons (LMN)causes muscle weakness and atrophy (amyotrophy). Destruction of upper motor neurons (UMN)in the cortex, corticospinal and corticobulbar tracts results in lateral sclerosis (Martin & Kessler, 2016). Demyelination, axonal swelling and atrophy in within the cerebral cortex, premotor areas, sensory cortex and temporal cortex cause the symptoms of ALS, the main symptom being muscle weakness (Giles, 2018).
The exact cause of ALS is idiopathic 90% of the time. It is more common in men than women and usually occurs between ages 40 and 70. About 5-10% of the time there is a genetic inheritance of an autosomal recessive dominant trait. Other theories of causative factors include a slow-acting virus, metabolic disturbances and theories related to toxicity of lead and aluminum (Giles, 2018).
Although early onset may involve only UMN or LMN, eventually both types will be affected. A patient with ALS has experiences fatigue, oral motor impairment, fasciculations, spasticity, motor paralysis and eventual respiratory paralysis, which is usually the cause of death. It is a rapidly progressive disease with an average course of 2-5 years. Only 20-30% survive longer than 5 years and those who are diagnosed before age 40 usually live longer (Giles, 2018).
The focus for physical therapy is on quality of life and maximizing the patient's functional capacity. Interventions should include range of motion, low-level exercise, mobility training, training in use of assistive/adaptive devices, wheelchairs, bronchial hygiene and energy conservation techniques. Caregivers and family members should be included in in training. Later in the disease process they will need to be capable of proper positioning, bronchial hygiene, ROM and helping with mobility. Physical therapy will help with whatever current issues the patient is facing but will not slow the progression of the disease (Giles, 2018).
Giles, S.M., (2018). PTA Exam, The Complete Study Guide. Scarborough, Maine: Scorebuilders.
Martin, S. & Kessler, M., (2016). Neurologic Interventions for Physical Therapy, Third Edition. St. Louis, MO: Elsevier/Saunders.
Parkinson's Disease (PD)
PD was first described back in 1817 by James Parkinson in an essay on the "shaking palsy". It's a chronic, progressive, neurological condition that affects the motor system. The four major symptoms of PD are bradykinesia, rigidity, tremors and postural instability. These symptoms are caused by a decrease in a neurotransmitter called dopamine which is stored in the substantia nigra, a part of the basal ganglia. The main purpose of the basal ganglia is to regulate posture and movement. Lesions develop in the basal ganglia that change the way the person moves (Martin & Kessler, 2016).
The risk for developing PD increases with age, with one in one hundred being affected after age 75. The average age of patients is 50-79 and about 10% are diagnosed before age 40. In recent years, Michael J. Fox drew attention to the disease when he was diagnosed with it at the age of 29.
Most PD patients will first notice a resting tremor of the hands (sometimes called "pill-rolling") or feet that increase with stress and disappear with movement or when asleep. Patients may notice things like trouble rolling over or getting out of bed, balance disturbances or trouble with fine motor skills like writing, getting dressed and bathing. They may at first think these issues are just signs of "old age." Symptoms will slowly progress and can include hypokinesia, akinesia and bradykinesia as well as dysphagia. They may even experience freezing while walking, talking blinking or moving their arms. Often a patient may develop a mask-like appearance, lacking facial expression. Symptoms will continue to worsen causing inactivity and deconditioning, which eventually allow for complications that lead to death (Giles, pg. 308).
Physical therapy interventions include maximizing strength and endurance, functional mobility and quality of life. Use of verbal and cues and visual feedback are helpful. Some things to focus on are balance activities, family education, gait training, stretching, trunk rotation, relaxation techniques, training in assistive/adaptive devices and respiratory therapy. Although PT cannot prevent further degeneration or cure PD, it will aid the patient in making the most of their level of function and quality of life (Giles, pg. 309).
Two programs have been developed in recent years that have been very successful in helping patients with PD slow down the progression of their disease. The videos below are about Rock Steady Boxing and LSVT Big.
Giles, S.M., (2018). PTA Exam, The Complete Study Guide. Scarborough, Maine: Scorebuilders.
Martin, S. & Kessler, M., (2016). Neurologic Interventions for Physical Therapy, Third Edition. St. Louis, MO: Elsevier/Saunders.
