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
www.ulloapt.com
Jorge Ulloa
www.ulloapt.com
