Amyotrophic Lateral Sclerosis (ALS)

Plain-language definition

Neurodegenerative disease affecting motor neurons. Physiotherapy support to maintain quality of life.

Signs and points requiring attention

• Progressive muscle weakness often starting in one limb (spinal form) or in speech and swallowing muscles (bulbar form). Involvement progressively extends to all voluntary muscles.
• Fasciculations (spontaneous visible muscle twitches under the skin) and muscle cramps, signs of motor neuron distress. These symptoms are often present from disease onset and can be painful.
• Progressive respiratory disorders from respiratory muscle involvement (diaphragm, intercostals): exertional then resting breathlessness, difficulty coughing, sleep apnea. Regular vital capacity monitoring essential.
• Swallowing difficulties (dysphagia) and speech difficulties (dysarthria) in bulbar forms: aspiration, drooling, nasal voice, fatigue when speaking and eating. Risk of malnutrition and aspiration pneumonia.

• Increasing respiratory difficulties, breathlessness at rest or when lying down, night awakening with suffocation sensation: signs of respiratory failure requiring prompt consultation.
• Repeated food aspiration, especially with liquids, coughing during meals, blockage sensation: risk of aspiration pneumonia. Consultation with speech therapist and physician.
• Significant weight loss despite maintained eating: may signal swallowing difficulties or hypermetabolism. Nutritional evaluation and dietary adaptation necessary.

Assessment and care

• Maintenance of joint mobility through gentle mobilizations and stretching: prevention of tendon contractures and pain from prolonged positions. Active work as long as possible, then passive.
• Respiratory physiotherapy adapted to progression: bronchial clearance, accessory respiratory muscle training, learning assisted cough techniques, expectoration assistance.
• Progressive adaptation of environment and assistive devices: wheelchair selection, communication aids, bed and home adaptation, installation of lifting systems if necessary.
• Comprehensive quality of life support: comfort maintenance, pain prevention, positioning, work with multidisciplinary team (speech therapist, occupational therapist, psychologist).

This information does not replace diagnosis or medical consultation.