Treatment of Amyotrophic Lateral Sclerosis
Author: mzPOTTER
Doctors can prescribe medicines to help reduce fatigue, reduce muscle cramps, control spasticity, and reduce excess saliva and phlegm. There are also medications available to help patients with pain, depression, sleep problems, and constipation. Pharmacists can advise on the use of drugs and monitor patient’s prescriptions to avoid the risk of dangerous interactions between drugs.
Physical therapy and special equipment can enhance the independence and security of patients in the course of ALS. Moderate aerobic exercise, low impact like walking, swimming or riding a stationary bike, can strengthen unaffected muscles, improve cardiovascular health and help patients fight fatigue and depression.
Exercises to improve range of motion and flexibility (stretching) can prevent spasticity and shortening (contracture) of muscles, which are very painful. Physical therapists can recommend exercises that provide these benefits without straining the muscles. Occupational therapists can suggest devices such as ramps, braces, walkers, and wheelchairs that help patients conserve energy and remain mobile.
Patients with ALS who have difficulty speaking may benefit from working with a speech therapist. These health professionals can teach patients adaptive strategies such as techniques to help them speak louder and clearer. As the disease progresses, speech therapists can help patients develop ways to answer questions in the affirmative or negative in your eyes, or other nonverbal means and can recommend equipment such as speech synthesizers and communication systems using computers. These methods and devices can help patients communicate when they can no longer speak or produce vocal sounds.
Patients and their caregivers can learn from speech therapists and nutritionists how to plan and prepare several small meals throughout the day to provide enough calories, fiber and liquids, and avoiding foods that are difficult to swallow. Patients may begin using suction devices to remove excess fluids or saliva and prevent choking. When patients can not obtain enough food eating, doctors may advise you to enter a feeding tube into the stomach. The use of a feeding tube also reduces the risk of choking and pneumonia that can result from aspiration of liquid into the lungs. The tube is not painful and does not prevent patients were fed orally if they wish.
When the muscles that assist in breathing weaken, you can use night ventilation assistance (intermittent positive pressure ventilation [IPPV, for its acronym in English] or bi-level positive pressure in the airways [BIPAP, for short English]) to help breathing when the patient is asleep. These devices artificially inflate the patient’s lungs through a number of external sources that are applied directly on the face or body. When the muscles can no longer maintain the levels of oxygen and carbon dioxide, these devices can be used all the time.
Eventually, patients may consider forms of mechanical ventilation (respirators) in which a machine inflates and deflates the lungs. To be effective, it may be necessary to use a tube that goes from the nose or mouth into the trachea and, if needed for a long time as a tracheotomy operation in which a plastic tube is inserted directly breathing in the patient’s trachea through an opening in the neck. Patients and their families should consider several factors when deciding whether to use one of these options and when. Ventilation devices differ in their effect on quality of life of patients and their cost. Although the use of a respirator may relieve breathing problems and prolong survival, its use does not affect the progression of ALS. Patients need to be fully informed about these considerations and long-term effects of a life of immobility before making a decision on the use of a respirator.
Social workers and nurses in home care or hospice care can help patients, their families and their carers with medical challenges, emotional and financial care in the face of ALS, especially in the final stages of the disease. Social workers can assist in obtaining financial assistance in making arrangements to draft a power or mandate for the period of incapacity (“durable power of attorney”) in the preparation of an Advance directives (“living will”), or in finding support groups for patients and their caregivers. The home care nurses are not only to provide medical care but also to teach caregivers to patients, tasks such as maintaining respirators, how to make the feeding tube and how to move patients to avoid painful skin problems and contractures. The home hospice nurses work in consultation with physicians to ensure proper medication, pain control and other care affecting the quality of life of patients who wish to remain in their homes. The hospice team that comes to the house can also counsel patients and their caregivers on issues related to life.