2. What is ALS?
Progressive neurodegenerative
disease in which the motor
neurons gradually degenerates
and after some time, they
eventually die.
3. Upper Motor Neuron -
evolving from layer five of
motor cortex to descend
via the pyramidal tract to
synapse with motor neuron
Lower Motor Neuron -consisting of
anterior horn cells in spinal cord
and their brainstem homologues
innervating bulbar muscle.
Loss of function in:
*Although at its onset, ALS may involve selective loss of function of only upper or lower motor neurons,
it ultimately causes progressive loos of both categories of motor neurons.
4. MOTOR NEURONS
Motor neuron is a type of
nerve that can be found in
the spinal cord, brain, and
brain stem. It provides a
connection between
voluntary muscle of the
body and nervous system
5. Causes Movement will not be
supported
Muscle weakens and
becomes thinner, inability to
control movement
Motor neurons
get affected
No action
potential
In ALS, MN get affected and so messages
cannot be initiated or transferred to the
muscles, this means movement will not
be supported in the muscles leads to
weakness of the muscles and they also
get thinner.
-As the condition reaches its later stages,
more and more MN are damaged and
more voluntary muscles fail to function
then a person will be unable to move
their limbs and body eventually leads to
complete paralysis
7. PATHOPHYSIOLOGY
It is unknown why the motor neuron
degenerate in ALS but researchers suggested
certain possibilities which are:
1. EXCITOTOXICITY
2. GENE MUTATION
9. PATHOPHYSIOLOGY
• GENE MUTATION –
SOD1 (superoxide
dismutase) is mutated in
some familial cases of
ALS. SOD1 which is a
cellular defense against
excitotoxicity which
detoxifies free radicals.
15. Late stage
• Dementia
•Respiratory failure
•Aspiration pneumonia
•Occulomotor nerve of extra ocular muscle
is affected
•May resemble locked in syndrome
25. Why keep the mouth clean?
-Maintain comfort
-Reduce halitosis
-Reduce risk for gum disease, which can further
endanger your health
-Reduce the risk of pneumonia (infection in the
lungs from bacteria in the mouth)
-Help manage saliva which can reduce drooling or
stimulate saliva flow
26. Physical changes that may occur with ALS might make it
difficult to keep the mouth clean. These include
1. Changes in hand/arm function
2. Changes in function of the mouth, lips, cheeks, and
tongue
3. Changes in function of the swallowing muscles
4. Changes in mobility
5. Changes in breathing
About 90-95% of ALS occur randomly and no apparent associated risk factor has been discovered yet
5-10% are inherited at birth
first see the effects of the disease in a hand or arm as they experience difficulty with simple tasks such as buttoning a shirt, writing, or turning a key in a lock. In other cases, symptoms initially affect one of the legs, and people experience awkwardness when walking or running or they notice that they are tripping or stumbling more often.
M.N shrink and disappear, so that the muscles no longer receive signals to move. As a result, the muscles become smaller and weaker. Gradually the body becomes paralyzed, which means that the muscles no longer work.
Glutamate is the major excitatory transmitter in the brain, it is responsible for sending signals b/n nerve cells.
Locked-in syndrome (LIS) is a condition in which a patient is aware but cannot move or communicate verbally due to complete paralysis of nearly all voluntary muscles in the body except for the eyes.one of its causes is als
Glutamate for learning and memory
Rilutek (riluzole) is an approved drug for the treatment of ALS. How it works is not exactly known, but it seems to prevent the damage that can result from the nerve cell being overexcited by glutamate. Studies have shown it may improve functioning and survival.
Regular exercise can also help improve your sense of well-being. Appropriate stretching can help prevent pain and help your muscles function at their best.
Because ALS affects the muscles you use to speak, communication becomes an issue as the disease progresses. A speech therapist can teach you adaptive techniques to make your speech more clearly understood. a speech therapist can recommend devices such as tablet computers with text-to-speech applications or computer-based equipment with synthesized speech that may help you communicate.
Hold a toothbrush and brush with it ..Turn a faucet on and off..Squeeze toothpaste from a tube.. Hold floss and move it between teeth..Open a container of mouthwash..Hold a cup to use for rinsing..Use a towel to wipe the mouth..Put dentures in and/or take them out
Clear food stuck in the mouth after swallowing a bite..Spit after brushing..Swish or hold water/mouthwash in mouth...Close mouth to avoid drooling.. Keep inside of mouth moistened
Clear mouth of saliva..Eat/drink to help stimulate saliva
Receive care in a traditional dental clinic exam chair..Perform daily oral care while sitting upright
Keep mouth moist during use of breathing equipment (such as a BiPAP®)..Close mouth to avoid drooling
Toothpaste dispenser (pump or hands-free)
Dental wipes
Oral irrigator (ex. WaterPik®, Water Flosser, Interplak® Water Jet)
Electric toothbrush
Floss holder
Tongue scraper
Dry mouth oral rinse
Mouth Swabs (ex. Toothette®- for moisture relief)
Portable oral suction device
Suction toothbrush (ex. Plak-Vak®)
Other adaptive equipment (ask for an evaluation by an Occupational Therapist)
Bite block bec of the paralysis of the mouth to keep mouth open
45degrees
drooling
To avoid spasticity and muscle weakness
-Continue visits to the dentist once every six months
-Update your medical history with the dentist’s office
-Discuss physical accommodations with the dentist’s office, For instance, can the dental office space accommodate a wheelchair?
-make short appointments
