NeuroRehabilitation - Volume 22, issue 6

Authors: McCluskey, Leo

Article Type: Editorial

DOI: 10.3233/NRE-2007-22601

Citation: NeuroRehabilitation, vol. 22, no. 6, pp. 407-408, 2007

Authors: Ferguson, Toby A. | Elman, Lauren B.

Article Type: Research Article

Abstract: Progressive loss of motor neurons causes Amyotrophic Lateral Sclerosis. Patients complain, most often, of progressive weakness in the distal limbs. However, weakness may manifest in any body segment (bulbar, cervical, thoracic, or lumbosacral). The diagnosis of ALS is suggested by clinical examination that reveals both upper and lower motor neuron failure. Formal diagnostic criteria have been developed and validated. Nerve conduction and electromyography studies improve diagnostic sensitivity and exclude some alternate, treatable diagnoses. Likewise, conventional imaging studies and laboratory evaluation refute other diseases that may masquerade as ALS. Experimental imaging and laboratory evaluations may improve ALS diagnosis in the future. …The cause of motor neuron death is not known but inherited forms of motor neuron disease may suggest mechanisms. The goal of ALS treatment is control of the symptoms of progressive weakness, especially respiratory insufficiency and dysphagia and is best managed in an integrated clinic. Show more

DOI: 10.3233/NRE-2007-22602

Citation: NeuroRehabilitation, vol. 22, no. 6, pp. 409-416, 2007

Authors: Palovcak, Merisa | Mancinelli, James M. | Elman, Lauren B. | McCluskey, Leo

Article Type: Research Article

Abstract: ALS is a neurodegenerative disease that affects nerve cells in the brain and spinal cord that control voluntary skeletal muscle. The muscle weakness that results from ALS is relentlessly progressive and rehabilitative attempts to strengthen affected muscles usually fail. When managing swallowing and communication disorders in individuals with ALS, the goals are to maximize function and safety through the use of compensatory strategies, energy conservation, and patient and caregiver education and counseling. This paper will review the current methods of assessment and treatment used with this population in the outpatient setting.

DOI: 10.3233/NRE-2007-22603

Citation: NeuroRehabilitation, vol. 22, no. 6, pp. 417-423, 2007

Authors: Elman, Lauren B. | Grossman, Murray

Article Type: Research Article

DOI: 10.3233/NRE-2007-22604

Citation: NeuroRehabilitation, vol. 22, no. 6, pp. 425-429, 2007

Authors: Golaszewski, Ame

Article Type: Research Article

DOI: 10.3233/NRE-2007-22605

Citation: NeuroRehabilitation, vol. 22, no. 6, pp. 431-434, 2007

Authors: Gregory, Susan A.

Article Type: Research Article

Abstract: Neuromuscular respiratory failure is the cause of death in the majority of patients with ALS. Respiratory muscle dysfunction impacts on quality of life and survival. Attentive management of respiratory muscle weakness is an important aspect of the management of the ALS patient. The respiratory muscles may be thought of as four functional groups: the inspiratory muscles, the expiratory muscles, the accessory muscles of respiration, and the upper airway muscles. This paper will review the structure and function of the neuromuscular respiratory system, and the evaluation and management of respiratory muscle dysfunction in ALS patients.

DOI: 10.3233/NRE-2007-22606

Citation: NeuroRehabilitation, vol. 22, no. 6, pp. 435-443, 2007

Authors: Brownlee, Alisa | Palovcak, Merisa

Article Type: Research Article

Abstract: When an individual has a severe verbal communication impairment, Augmentative and Alternative Communication (AAC) can meet the overall goals of palliative care. AAC can improve quality of life by optimizing function, assisting with decision making, and providing opportunities for personal growth. This article will define AAC and its importance in the medical management of a person with ALS. The process of obtaining an electronic AAC device, issues affecting use, and communication challenges and obstacles unique to ALS will be described including dysarthria and the diagnostic testing for speech and rationale for AAC. Communication solutions, which may include no-technology, low-technology and …high-technology options will be discussed, as well as the importance of psychosocial issues and the factors that may influence the use of these systems. Show more

DOI: 10.3233/NRE-2007-22607

Citation: NeuroRehabilitation, vol. 22, no. 6, pp. 445-450, 2007

Authors: Lewis, Michele | Rushanan, Scott

Article Type: Research Article

Abstract: Amyotrophic Lateral Sclerosis (ALS) is a progressive neuromuscular disease for which there is no cure. There is a general misunderstanding among healthcare professionals of the proper use and potential benefits of physical and occupational therapy to treat the symptoms and resulting loss of independence. These services can help maximize mobility and comfort through equipment prescription, activity adaptation, patient and family education, and the use of appropriate exercise and range of motion techniques. The literature is controversial on the prescription of exercise in this population. Individual muscle strength, fatigue and spasticity must all be taken into account when discussing exercise with …persons with ALS. It can be concluded that physical and occupational therapy intervention is beneficial to persons with ALS. However, more research is needed to decisively determine the effects of exercise on the person with ALS. Show more

DOI: 10.3233/NRE-2007-22608

Citation: NeuroRehabilitation, vol. 22, no. 6, pp. 451-461, 2007

Authors: McCluskey, Leo

Article Type: Research Article

Abstract: The variable clinical course of Amyotrophic Lateral Sclerosis (ALS) confronts the clinician, the patient and caregivers with many ethical challenges from the moment of breaking the news of the diagnosis and throughout the relentlessly progressive trajectory of the disease. Each patient faces the prospect of life-threatening bulbar and respiratory muscle dysfunction that may ensue soon after disease onset or after months or years of progressive weakness. This reality eventually forces the patient to choose life extension via gastrostomy tube insertion, mechanical ventilation or both or to forego these treatments in favor of terminal palliative care. Faced with these prospects some …patients contemplate voluntary cessation of food and water, physician assisted suicide or euthanasia. Depending upon the presence and severity of frontotemporal dementia (FTD) related to frontotemporal lobar degeneration (FTLD) the capacity to make these forced choices may be compromised. Clinicians caring for ALS patients should appreciate and communicate the significance of life threatening symptoms, monitor capacity for decision making, anticipate and manage multiple possible end of life scenarios, and aggressively manage symptoms. Show more

DOI: 10.3233/NRE-2007-22609

Citation: NeuroRehabilitation, vol. 22, no. 6, pp. 463-472, 2007