ALS and Related Disorders Overview

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Questions and Answers

What is a characteristic of Stage III ALS?

Severe weakness in ankle, feet, and hands (correct)

Improved respiratory function

Significant muscle strength in the legs

Enhanced capability in activities of daily living

In ALS Phase I, what type of medical referral might be necessary for foot weakness?

PT or Ortho referral (correct)

Psychological referral

Dietary referral

Cardiology referral

Which intervention is not recommended for a patient in Stage III ALS?

Manual or power wheelchair

High-intensity strength training (correct)

Education on bathroom equipment

Home modification

Which of the following is aimed at keeping ALS patients as independent as possible?

Encouraging deep breathing exercises Signup and view all the answers

What symptom is commonly associated with Stage III ALS?

Increased fatigue with long ambulation Signup and view all the answers

What are common sites for pressure ulcers during the acute phase?

Sacrum and heels Signup and view all the answers

Which of the following is an effective prevention strategy for pressure ulcers?

Cushion use Signup and view all the answers

During which stage of Parkinson’s Disease do the signs become bilaterally impaired, but balance is not affected?

Stage II Signup and view all the answers

What is the recommended frequency for repositioning a patient to prevent pressure ulcers?

Every 30 minutes to 1 hour Signup and view all the answers

At what age is early onset Parkinson’s Disease defined?

50 years or less Signup and view all the answers

Which seating or mobility aid is recommended for pressure relief?

Sliding board Signup and view all the answers

In which stage of Parkinson's Disease is the condition considered functionally disabling?

Stage IV Signup and view all the answers

Which is a less common site for pressure ulcers?

Scapula Signup and view all the answers

What is a symptom associated with Progressive Bulbar Palsy?

Dysarthria Signup and view all the answers

Which of the following symptoms is indicative of Primary Lateral Sclerosis?

Progressive Spastic paresis Signup and view all the answers

What is the primary biological basis for Progressive spinal muscular atrophy?

Lower motor neurons damage Signup and view all the answers

Fasciculations are generally associated with which type of condition?

Lower motor neuron damage Signup and view all the answers

What is a common symptom of ALS that affects swallowing?

Dysphagia Signup and view all the answers

Individuals with symptoms of muscle wasting are likely experiencing issues with which part of the nervous system?

Lower motor neurons Signup and view all the answers

Which of the following is NOT a symptom of Progressive Bulbar Palsy?

Spasticity Signup and view all the answers

What aspect of ALS is highlighted by muscle wasting of limbs and trunk?

Lower motor neuron lesions Signup and view all the answers

What is the highest stage in the Modified Hoehn and Yahr Scale?

Stage 5 Signup and view all the answers

Which part of the UPDRS focuses on self-evaluation of activities of daily living (ADLs)?

Part II Signup and view all the answers

At which stage in the Modified Hoehn and Yahr Scale does bilateral involvement occur without impairment of balance?

Stage 2 Signup and view all the answers

Which section of the UPDRS is focused on clinician-scored motor evaluation?

Part III Signup and view all the answers

What kind of involvement is observed in Stage 1.5 of the Modified Hoehn and Yahr Scale?

Unilateral and axial involvement Signup and view all the answers

In the context of OT's role, what aspect is NOT a focus depending on the stage of Parkinson's disease?

Pharmaceutical interventions Signup and view all the answers

What defines Stage 3 in the Modified Hoehn and Yahr Scale?

Moderate bilateral disease with postural instability Signup and view all the answers

Which scale measures the severity of Parkinson’s Disease through various stages?

Unified Parkinson’s Disease Rating Scale Signup and view all the answers

What is a characteristic of Stage I in ALS Phase I?

Clumsiness Signup and view all the answers

Which occupational therapy intervention might be needed to support a patient in Stage II of ALS?

Adaptation of tasks Signup and view all the answers

What does the acronym AFO stand for in the context of orthotic devices?

Ankle Foot Orthosis Signup and view all the answers

In the context of ALS Phase I, what is a recommended intervention for a patient experiencing mild weakness?

Energy conservation Signup and view all the answers

What indicates a likely complication in Stage II ALS when a patient finds it difficult to raise arms?

Progressive weakness Signup and view all the answers

Which of the following diagnoses can ankle foot orthoses (AFO) be used for?

Stroke (CVA) Signup and view all the answers

What is a common challenge faced by individuals in Stage II of ALS when performing daily tasks?

Difficulty with fine motor tasks like buttoning clothing Signup and view all the answers

What intervention may be necessary for a patient in Stage II of ALS who shows signs of dysphagia?

Baseline dysphagia management Signup and view all the answers

Study Notes

Progressive Bulbar Palsy

Bulbar tracts and brainstem are affected
Symptoms include dysarthria, dysphagia, facial and tongue weakness, and wasting

Progressive Spinal Muscular Atrophy

Lower motor neurons in the spinal cord and brainstem are affected
Symptoms include muscle wasting in limbs, trunk, and sometimes the bulbar muscles

Primary Lateral Sclerosis

Corticospinal and corticobulbar regions are affected
Symptoms include progressive spastic paresis (progressive weakness and stiffness in the legs)

ALS Phase I

Characteristics: mild weakness, clumsiness, ambulation, independent with ADLs
OT interventions: normal activities, energy conservation, providing opportunity for voice concerns, range of motion exercises, gentle resistance exercises

ALS Phase II

Characteristics: moderate selective weakness, slight decrease in ADLs, difficulty climbing stairs, difficulty raising arms for buttoning clothing or tying shoes, baseline dysphagia
OT interventions: assess self-care, work, and leisure, adapt tasks, provide DME, orthotics as needed, stretching, cautious strength/resistance exercises (nothing over 3+/5), orthotics

ALS Phase III

Characteristics: severe weakness in ankle, feet, hands, moderately decreased ADLs, easily fatigued especially during long ambulation, slightly increased respiratory effort
OT interventions: manual or power wheelchair, leg rests, trunk supports, adapt or provide DME, home modifications, education on bathroom equipment, keep the patient as independent as possible, encourage deep breathing exercises

Complications: Pressure Ulcers

Common sites: sacrum, heels (acute phase), ischial tuberosities, trochanters (subacute/chronic phase), occiput, scapula, malleoli, metatarsals (less common)

Prevention: Pressure Ulcers

Implement pressure relief maneuvers, heel reliefs, ankle foot orthotics, specialty beds, wheelchair cushions, bowel/bladder management strategies, and patient/family education.

Prevention: Pressure Ulcers - Repositioning

Reposition every 30 minutes to 1 hour or more frequently
Use pressure relief techniques
Weight shifts

Prevention: Pressure Ulcers – Friction and Shearing

Avoid friction and shearing
Ensure proper cushion use
Use a sliding board
Encourage use of commodes and modified wheelchairs

Parkinson's Disease

Early onset affects 3% of individuals 50 years of age or less
Stages:
- Stage I: Symptoms are one-sided
- Stage II: Symptoms are bilateral but balance is not impaired
- Stage III: Symptoms are bilateral and balance is impaired
- Stage IV: PD is functionally disabling
- Stage V: The person is confined to bed or a wheelchair.

Severity of Parkinson’s Disease Rating Scales

Unified Parkinson’s Disease Rating Scale (UPDRS)
- Part I: Evaluation of mentation, behavior, and mood
- Part II: Self-evaluation of ADLs including speech, swallowing, handwriting, dressing, hygiene, falling, salivating, etc.
- Part III: Clinician-scored motor evaluation
- Part IV: Complications
Hoehn and Yahr (stages 0-5, describing severity)
Schwab and England ADL (ADL scale)

OT’s Role in Parkinson’s Disease

Depends on the client’s stage of PD, focus on:
- Compensatory strategies
- Client and family education
- Environment and task modifications
- Community involvement

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Description

This quiz provides an overview of Amyotrophic Lateral Sclerosis (ALS) and related neurological conditions such as Progressive Bulbar Palsy, Progressive Spinal Muscular Atrophy, and Primary Lateral Sclerosis. It highlights symptoms, affected areas, and occupational therapy interventions across different phases of ALS care.