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lunes, 31 de diciembre de 2012

ALS and Physical Therapy

 Physical therapy
A physical therapist is trained to help people perform activities that require major muscle groups. For people with ALS, a physical therapist may focus on mobility issues such as walking, getting in and out of bed, or standing from a chair. The goal is to keep ALS patients as active as possible for as long as possible.
Physical therapy can improve mobility, relieve pain, and can delay or limit permanent physical disabilities. A physical therapist can suggest exercise regimens  that can help maintain and promote overall good health.
Testing and evaluation will help a physical therapist see a patient's overall level of functioning during various stages of ALS. From these tests, a therapist can advise a patient about what equipment or adaptive devices might help accomplish everyday tasks.

Respiratory therapy
For people with ALS, it is important to carefully monitor respiratory function. Likewise, therapy instruction is essential to overall care.
Therapy for ALS respiratory dysfunction is aimed at supportive measures. Considerations may include:
·         Using ventilatory maneuvers to prevent lung collapse
·         Beginning a smoking cessation program (if the person is a smoker)
·         Maintaining nutrition and preventing aspiration (taking food or fluid into the lungs)
·         Getting flu vaccinations
·         Prescribing medications to decrease the work of breathing.  

When should I see a Physical Therapist?
If you have questions regarding exercise guidelines, stretching, or other activity recommendations, it may be helpful for you to meet with a physical therapist during your clinic visit to discuss these questions.  

If you are experiencing difficulty with balance, walking, endurance, transfers, or functional activities, it is likely a good time to seek the input of a physical therapist, either locally or at your next clinic visit. 

If you have fallen or stumble sometimes, seeing a physical therapist for consultation may help to identify the cause of these incidents, and suggest a plan going forward to minimize your risk of falls.  This plan may include ongoing PT treatment (locally, near your home, or in your home), a device (such as an ankle brace or other assist) to help you clear your feet when walking, or other techniques or treatment options.  If you fall in-between clinic visits, please DO NOT WAIT until the next clinic visit to tell your neurologist and/or the ALS clinic physical therapist about your fall.  We recommend that you call us to let us know right away, so we can help you problem-solve and identify local resources, such as PT and OT, to help maximize your function and decrease your risk of further falls.

Why is exercise important for the patient with Neuromuscular Disease?
A common perception regarding patients with neuromuscular disease is that since the muscles won't get stronger, it will not help to exercise, and recommendations regarding exercise for those with neuromuscular disease have long been controversial.  Some experts believe it’s impossible to overdo it, while others believe exercising to exhaustion can "burn out" remaining motor neurons before their time.  Some physical therapy experts have raised questions about whether it’s wise to put too much demand on a gradually decreasing number of motor neurons, which have to do the work that would normally be done by many more such cells.  
In the past several years, some small research studies have shown that moderate exercise, both aerobic and light strengthening, may be beneficial.  More research is needed (and is currently planned) to determine how much exercise is enough and how much is “too much.”  Based on what we currently know, it seems sensible to exercise with discretion and stop before reaching the point of exhaustion.  Researchers are also investigating what type of exercise is safest and most tolerated in patients with ALS.  

We feel that appropriate exercise is very beneficial for patients with neuromuscular disease, for the following reasons:
•    To prevent joint stiffness and maintain joint mobility allowing for easier performance with self care tasks. 
•    To keep muscle tissue that is not affected by neuromuscular disease healthy and strong.  Healthy muscle tissue can better support the weak muscles.
•    To maintain cardiopulmonary fitness as much as possible
•    To possibly delay muscle atrophy (decrease in muscle size) because of disease. 

Beneficial types of exercise (within individual activity tolerance):
•    Active Movement
•    Low impact activity, such as stationary bicycle, pool exercises, walking, movement
•    Light resistance if using weights
•    Assisted Movement (movement in which another person assists)

Dos and Don’ts in Exercise for people with Neuromuscular Disease:
•    Do take short rest periods throughout the day and space activities over several hours
•    Do save energy for necessary daily activities.
•    Don’t perform exercise to the point of severe fatigue. 
•    Don’t “feel the burn” or push yourself until you are sore after exercise or the next day

Jorge Ulloa