What is the role of occupational therapy in the treatment of amyotrophic lateral sclerosis (ALS)?

Updated: Jan 02, 2020
  • Author: Divakara Kedlaya, MBBS; Chief Editor: Ryan O Stephenson, DO  more...
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Occupational therapists should focus on teaching energy conservation techniques to the patient with amyotrophic lateral sclerosis (ALS) and his/her caregivers. Adaptive equipment should be introduced early and in synchronization with the patient's progressing needs. [8]

Upper extremity bracing can be used in cases where weakness may alter joint biomechanics. Patients with poor grasp can be provided with a universal cuff, and patients with hand weakness can be braced in 20-25° of extension to improve grip strength. For patients with proximal upper extremity weakness, a balanced forearm orthosis (ie, deltoid aid) may be beneficial to enhance upper extremity movement by eliminating the effects of gravity. When shoulder girdle weakness progresses to advanced stages, slings can be used to decrease pain by limiting traction on the associated ligaments, nerves, and vessels.

For patients with severe limb involvement, introduce environmental control units (ECUs) that utilize oral-motor movements. In patients with severe bulbar involvement, extraocular movements are usually preserved so ECUs incorporating eye gaze technology can be used. [16]

A literature review by Arbesman and Sheard of studies evaluating the effects of occupational therapy on patients with ALS found limited-to-moderate evidence that multidisciplinary programs are associated with longer survival than are general care programs. The review, which encompassed 14 studies, also found limited evidence that, compared with general care programs, multidisciplinary programs lead to the use of a higher percentage of appropriate assistive devices or that patients in these programs have a higher quality of life with regard to social functioning and mental health. [17]

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