1.
MANAGEMENT OF ALS
Complete PT guidelines

2.
EXERCISE & REHAB
PHASE 1 (INDEPENTANT)
Stage one:
Pts might be having mild weakness, clumsy,
ambulatory, complete independent in ADLs
PT : continue normal activities, prevent atrophy,
Begin ROM ex (yoga, stretch, gentle
resistance ex, avoid over fatigue,
psychological support

3.
 Stage two:
Moderate weakness, slightly decrease in
independent
( need min assistance in higher level activates )
Difficulties in climbing stairs, raising arm, buttoning
PT: Continue stretching to avoid contractures,
strengthen the muscles with grade 3 +, monitor
the fatigue and over use soreness
Consider AFO, Hand splints, use adaptive devices
to improve gait

4.
 Stage three:
Severe weakness in ankles, wrists, hands
Moderate independent in ADL
Fatigue with long distance ambulation
Slightly increased respiratory effort (BBS)
PT: Continue stage 2 as much tolerates
Caution not to fatigued
Keep the pts independent as much possible
Encourage deep breathing ex, and other ventilatory
muscles training, chest clearance

5.
PHASE 2 (PARTIALLY INDEPENTANT)
Stage four:
Hanging arm syndrome, shoulder pain, oedema
Wheel chair dependant
Severe LL weakness, with or without spasticity
Able to perform ADL with max support with extreme
fatigue
PT: Heat, massage (spasm)
Oedema prevention, shoulder joint support,
isometric ex, motor wheel chair

6.
 Stage five:
Severe weakness all the muscles
Moderate UL weakness
Wheel chair dependant
Pressure sores, contractures, scoliosis, etc
PT: Care givers education on care and ADL,
transfers
Environmental modifications, respiratory
support,
Anti-pressure matters

7.
PHASE 3 (DEPENTANT)
Stage six:
Bed ridden, complete depentant
PT: Dysphagia Rx, soft diet, tube feedings,
percutaneous gastroctomy
Drooling management, prevent aspiration, chest
clearance, electronic speech amplification,
treachestomy,