23 lines
6.0 KiB
Markdown
23 lines
6.0 KiB
Markdown
---
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title: "ALS"
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chunk: 9/11
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source: "https://en.wikipedia.org/wiki/ALS"
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category: "reference"
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tags: "science, encyclopedia"
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date_saved: "2026-05-05T11:04:10.701513+00:00"
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instance: "kb-cron"
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---
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==== Invasive ventilation ====
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Invasive ventilation bypasses the nose and mouth (the upper airways) by making a cut in the trachea (tracheostomy) and inserting a tube connected to a ventilator. It is an option for people with advanced ALS whose respiratory symptoms are poorly managed despite continuous NIV use. While invasive ventilation prolongs survival, especially for those younger than 60, it does not treat the underlying neurodegenerative process. The person with ALS will continue to lose motor function, making communication increasingly difficult and sometimes leading to locked-in syndrome, in which they are completely paralyzed except for their eye muscles. About half of the people with ALS who choose to undergo invasive ventilation report a decrease in their quality of life, but most still consider it to be satisfactory. However, invasive ventilation imposes a heavy burden on caregivers and may decrease their quality of life. Attitudes toward invasive ventilation vary from country to country; about 30% of people with ALS in Japan choose invasive ventilation, versus less than 5% in North America and Europe.
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=== Therapy ===
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Physical therapy plays a large role in rehabilitation for individuals with ALS. Specifically, physical, occupational, and speech therapists can set goals and promote benefits for individuals with ALS by delaying loss of strength, maintaining endurance, limiting pain, improving speech and swallowing, preventing complications, and promoting functional independence.
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Occupational therapy and special equipment such as assistive technology can also enhance people's independence and safety throughout ALS. Gentle, low-impact aerobic exercise such as performing activities of daily living, walking, swimming, and stationary bicycling can strengthen unaffected muscles, improve cardiovascular health, and help people fight fatigue and depression. Range of motion and stretching exercises can help prevent painful spasticity and shortening (contracture) of muscles. Physical and occupational therapists can recommend exercises that provide these benefits without overworking muscles because muscle exhaustion can lead to a worsening of symptoms associated with ALS, rather than providing help to people with ALS. They can suggest devices such as ramps, braces, walkers, bathroom equipment (shower chairs, toilet risers, etc.), and wheelchairs that help people remain mobile. Occupational therapists can provide or recommend equipment and adaptations to enable people with ALS to retain as much safety and independence in activities of daily living as possible. Since respiratory insufficiency is the primary cause of mortality, physical therapists can help improve respiratory outcomes in people with ALS by implementing pulmonary physical therapy. This includes inspiratory muscle training, lung volume recruitment training, and manual assisted cough therapy aimed at increasing respiratory muscle strength as well as increasing survival rates.
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People with ALS who have difficulty speaking or swallowing may benefit from working with a speech-language pathologist. These health professionals can teach people adaptive strategies, such as techniques to help them speak louder and more clearly. As ALS progresses, speech-language pathologists can recommend the use of augmentative and alternative communication such as voice amplifiers, speech-generating devices (or voice output communication devices), or low-tech communication techniques such as head-mounted laser pointers, alphabet boards, or yes/no signals.
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=== Nutrition ===
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Preventing weight loss and malnutrition in people with ALS improves both survival and quality of life. Weight loss in ALS is often caused by muscle wasting and increased resting energy expenditure. Weight loss may also be secondary to reduced food intake since dysphagia develops in about 85% of people with ALS at some point throughout their disease course. Therefore, regular periodic assessment of the weight and swallowing ability in people with ALS is very important. Dysphagia is often initially managed via dietary changes and modified swallowing techniques. People with ALS are often instructed to avoid dry or chewy foods in their diet and instead have meals that are soft, moist, and easy to swallow. Switching to thick liquids (like fruit nectar or smoothies) or adding thickeners (to thin fluids like water and coffee) may also help people facing difficulty swallowing liquids. There is tentative evidence that high-calorie diets with a focus on "good fats" rather than simple carbohydrates, may prevent further weight loss and improve survival, but more research is still needed.
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A feeding tube should be considered if someone with ALS loses 5% or more of their body weight or if they cannot safely swallow food and water. This can take the form of a gastrostomy tube, in which a tube is placed through the wall of the abdomen into the stomach, or (less commonly) a nasogastric tube, in which a tube is placed through the nose and down the esophagus into the stomach. A gastrostomy tube is more appropriate for long-term use than a nasogastric tube, which is uncomfortable and can cause esophageal ulcers. The feeding tube is usually placed by a radiologically inserted gastrostomy (RIG) or a percutaneous endoscopic gastrostomy procedure (PEG), depending on the hospital involved and the patient's medical history. Since there is considerable evidence that feeding tubes improve survival in people with ALS by avoiding malnutrition and dehydration if their swallowing abilities has been lost, no randomized controlled trials (RCTs) have been conducted to indicate whether enteral tube feeding has benefits compared to continuation of feeding by mouth. Accordingly, PEG tubes are offered with the intent of improving the person's quality of life as well as survival, by sustaining nutrition, hydration status, and medication intake. |