This document outlines a course on Amyotrophic Lateral Sclerosis (ALS) presented by Professor Kathy Mitchell. The course covers what ALS is, available community and healthcare resources, assessing client needs, managing the physiological and psychosocial impacts, caring for clients at home, ethical issues, and current and future research. ALS is a progressive neuromuscular disease that attacks motor neurons. An interdisciplinary healthcare team provides holistic care to address ALS clients' physical and psychosocial needs as the disease progresses and causes paralysis. While currently incurable, advances in treatment aim to slow progression and improve quality of life.

1. Amyotrophic Lateral
Sclerosis
Presented by
Professor Kathy Mitchell
Algonquin College
Ottawa Ontario Canada

2. COURSE CONTENT
 1. What is ALS
 2. Community Resources
 3. Health care team
 4. Assessment of client’s needs
 5. Physiological and Psychosocial needs
 6. Managing the illness at home
 7.Ethical issues and decision making
 8.Research and hope for the future

3. ALS
 Lou Gehrigs’ disease-June 2 1941-
United States-age 37
 Motor Neurone Disease-Europe
 Maladie de Charcot -1840

4. ALS
 Progressive degenerative neuromuscular
disease
 Attacks motor neurons which control
voluntary muscles-movement of arms legs
 Muscles used in swallowing, breathing and
talking
 Does not affect: Cognitive status
 Vision and eye movement
 Sensory system
 Bowel/bladder/sexual function

5. Types
 Sporadic-90-95%
 No family history
 Familial-5-10%
 Adult Familial-gene defect on
chromosome 21
 20% have deficiency of SOD1-super
oxide dismutase enzyme

6. Physiology
 No known cause or cure
 Not contagious or infectious
 Age dependent-80% of all cases
between 40-70
 Life expectancy 18 months-5 years
 Men 1.5 ratio to 1.0 women

7. Diagnosis
 Done by excluding other illnesses
 El Escorial ALS diagnostic criteria
 History, Physical , Neurological exam
 Signs of upper or lower motor neuron
degeneration with progressive spread

8. Clinical symptoms
 Muscle weakness
 Muscle atrophy
 Shortness of breath
 Slurred speech
 Occasional choking

9. Limb Onset
 Weakness
 Fasciculations-involuntary muscle
twitches
 Atrophy-muscle deterioration
 Dysarthria-inability to articulate words
 Respiratory impairment
 Progressive muscular weakness

10. Bulbar onset
 Speech disorder-weakness in
tongue,jaw lips-dysarthria
 Difficult swallowing-dysphagia
 Respiratory problems-dyspnea
 Excessive salivation-sialorrhea
 Fatigue

11. Disease Progression
 Client specific- Length of illness
unpredictable
 Paralysis of voluntary muscles
 Atrophy
 Cause of death-respiratory failure

12. Interdisciplinary Team
 All team members contribute from their
own professional expertise to support
the client and family
 Nursing Model of Assessment is based
on the work of Calista Roy

13. Health Team
 Person with ALS
 Family
 Physician/physiatrist
 Registered Nurse
 Physiotherapist
 Occupational Therapist
 Speech Therapist
 Nutritionist

14. Health Team
 Social Worker
 Pastoral care Worker
 Home Care worker
 Community based care-mobility
 Respiratory Therapist
 Palliative care

15. Holistic Care
 Disease progress is unpredictable
 Continuous assessment, implementation
and evaluation of needs of client and
family
 Communication with health care team is
ongoing
 Physical and psychosocial needs create
major challenges

16. Physiologic Needs
 Oxygenation
 Nutrition
 Fluids and electrolytes
 Elimination-Bowel and Bladder
 Activity and Rest
 Protection

17. Psychosocial Needs
 Self concept
 Role function
 Interdependence

18. Current Treatments
Home care based
Long term management of client problems
Medication-to alleviate symptoms
Physical therapy-maximize capabilities
Speech therapy augmented communication
Nutrition-p.e.g. tube
Ventilation-non-invasive vs invasive

19. Hope for the Future
 Longer prognosis
 Live beyond five years
 Physical impairment will move slowly
 Assistive devices will maintain independence
 Minimum of suffering
 Drug therapy will progress-Riluzole
 Effective symptom management

20. Hope for the Future
 Positive attitude
 Firm belief system
 Support of family and friends
 Spirituality
 Hiroshi Mitsumoto Columbia University

21. Спасибо доктору Льву
Брылеву и Фонду
«Живи Сейчас»!

22. Contact details Ottawa
 Kathy Mitchell R.N. B.N.
 613 727-4723 ext 5389
 www.algonquincollege.com
 Email: mitchek@algonquincollege.com