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Background and Purpose. This case report describes the use of Sinaki and Mulder's approach to staging amyotrophic lateral sclerosis (ALS) and functional outcome measures in designing a treatment program for a 59-year-old woman with ALS. Case Description and Outcomes. As the patient progressed from stage I through stage VI, over 12 months, the physical therapy goals changed from optimizing remaining function, to maintaining functional mobility, and finally to maximizing quality of life. Discussion. Disease staging and the use of functional outcome measures provide a framework for physical therapy evaluation and treatment of patients with ALS throughout the disease process. Physical therapists can assist patients with ALS through the provision of education, psychological support, rehabilitation programs, and recommendations for appropriate equipment and community resources. [Dal Bello-Haas V, Kloos AD, Mitsumoto H. Physical therapy for a patient through six stages of amyotrophic lateral sclerosis. Phys Ther. 1998;78:1312-1324.]
Key Words: Amyotrophic lateral sclerosis, Physical therapy, Staging of disease.
Amyotrophic lateral sclerosis (ALS) is the most common motoneuron disease among adults.1 The incidence of ALS is 0.4 to 2.4 cases per 100,000 people worldwide, with a prevalence of 2.5 to 7 cases per 100,000 people.1-3 Amyotrophic lateral sclerosis is slightly more common in men than in women, and the average age of onset is the mid 50s. In 5% to 10% of people with ALS, the disease is inherited as an autosomal dominant trait and is referred to as familial amyotrophic lateral sclerosis.1-3 In 90% to 95% of people with ALS, there is no family history of the disease, and these people are said to have sporadic amyotrophic lateral sclerosis.1-3
In people with ALS, motoneurons in the spinal cord, brain stem, and cerebral motor cortex degenerate and result in a variety of signs and symptoms (Tab. 1 ) .1,2 The most frequent initial symptom, which occurs in more than 70% of patients, is focal weakness beginning in the leg, arm, or bulbar muscles.l Amyotrophic lateral sclerosis is characterized by the absence of sensory symptoms and findings, although pathological conditions have been found in the sensory systems of some patients with ALS.1 Cognition, extraocular eye movements, and autonomic, bowel, bladder, and sexual functions usually remain intact.l-3
Muscle weakness progresses over time, and the pattern and rate of physical...