Physical therapy for individuals with amyotrophic lateral sclerosis: current insights

Degenerative Neurological and Neuromuscular Disease Dovepress open access to scientific and medical research REVIEW Degenerative Neurological and Neuromuscular Disease downloaded from https://www.dovepress.com/ by 88.198.20.149 on 05-May-2021 For personal use only. Open Access Full Text Article Physical therapy for individuals with amyotrophic lateral sclerosis: current insights This article was published in the following Dove Press journal: Degenerative Neurological and Neuromuscular Disease Vanina Dal Bello-Haas Physiotherapy Program, School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada Introduction Correspondence: Vanina Dal Bello-Haas Physiotherapy Program, School of Rehabilitation Science, McMaster University, 1400 Main Street West, 403/E, Hamilton, ON L8S 1C7, Canada Tel +1 905 525 9140 ext 27822 Fax +1 905 524 0069 Email Amyotrophic lateral sclerosis (ALS) is a progressive, neurodegenerative, and inevitably fatal disease associated with loss of upper and lower motor neurons.1 There is no cure for ALS, life expectancy is typically 2–5 years after symptom onset, and the only approved drug, riluzole, has a modest effect on survival.2 The clinical management of people with ALS (PALS) is complex and requires a comprehensive and multidisciplinary approach. There is an increasing interest in a rehabilitation approach toward PALS, as illustrated in Figure 1, with an increasing number of articles published related to rehabilitation for PALS or specific elements of rehabilitation, such as exercise and falls. The sharp increase in the number of articles since the year 2000 indicates the ever-expanding interest related to these themes. The Latin root of rehabilitation, rehabilitare – “to provide again with means” – exemplifies the optimal approach to care of PALS; as does active living, whereby healthy, optimal, and productive living is paramount irrespective of disease state. Effective management of PALS is complex and requires a comprehensive and multidisciplinary approach. Physical therapy is an integral component of the ALS multidisciplinary team and is well grounded in rehabilitation and active living concepts. Despite the lack of a cure and rapidly progressive nature of the disease, physical therapy that is tailored to the individual’s needs and goals, and focused on addressing the symptoms and maximizing the function and participation enables PALS to live their lives to the fullest and with quality. The purpose of this paper is to review some of the 45 submit your manuscript | www.dovepress.com Degenerative Neurological and Neuromuscular Disease 2018:8 45–54 Dovepress © 2018 Dal Bello-Haas. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). http://dx.doi.org/10.2147/DNND.S146949 Powered by TCPDF (www.tcpdf.org) Abstract: Amyotrophic lateral sclerosis (ALS) is a progressive, neurodegenerative, and inevitably fatal disease. There is no cure for ALS and life expectancy is typically 2–5 years after symptom onset. Despite the lack of a cure and the rapidly progressive nature of the disease, ALS is considered a “treatable disease” and rehabilitation is integral to optimal, comprehensive care. In addition to the other health care professions making up the health care team, physical therapy provides a critical role in the overall management in individuals with ALS. Physical therapy that is tailored to the individual’s needs and goals and focused on addressing symptoms and maximizing function and participation enables people with ALS to live their lives to the fullest and with quality. The purpose of this paper is to review some of the recent ALS research findings that have implications for physical therapy practice. Keywords: amyotrophic lateral sclerosis, physical therapy, disease stage, falls, exercise, pain, cognition Dovepress Dal Bello-Haas 700 Number of articles published Degenerative Neurological and Neuromuscular Disease downloaded from https://www.dovepress.com/ by 88.198.20.149 on 05-May-2021 For personal use only. 600 500 400 300 Falls 200 Disease stage Exercise Rehabilitation 100 0 1970–1979 1980–1989 1990–1999 2010–2017 Figure 1 PubMed search results, 1970 to 2017: Amyotrophic lateral sclerosis and rehabilitation, amyotrophic lateral sclerosis and disease stage, amyotrophic lateral sclerosis and falls, and amyotrophic lateral sclerosis and exercise. recent research findings that have implications for physical therapy for PALS in general, and related to physical therapy evaluation and treatment for PALS specifically. Although not a systematic review, the research evidence published within the past 5 years was systematically searched using the following databases (CINAHL, Cochrane, Web of Science, PubMed, OVID) to address the specific objectives of this paper: 1) to describe important and relevant recent research breakthroughs and implications for physical therapy practice; and, 2) to describe the most recently published ALS research related to cognitive, behavioral, and psychological impairments, respiratory impairments, falls, pain, and exercise. ALS: more than just a motor disease? There is increasing evidence that ALS should be regarded as a multisystem health condition rather than solely a motor disease. Clinical, genetic, and postmortem studies have demonstrated that there is considerable variability in the phenotypic expression of ALS.3–7 Neuropathological and imaging findings have confirmed that ALS includes various non-motor (extrapyramidal) areas.3–5 Regions beyond the motor system affected by ALS include the autonomic nervous system, the basal ganglia, and the cerebellar, frontotemporal, oculomo- 46 Powered by TCPDF (www.tcpdf.org) 2000–2009 Year submit your manuscript | www.dovepress.com Dovepress tor, and sensory systems.8,9 More recent ALS research has greatly enhanced the knowledge and understanding of the genetics and molecular mechanisms of the disease. Over 20 chromosomal regions and a number of identified genes have been linked to ALS. A substantial proportion of familial ALS (FALS) has now been traced to an expansion of the intrinsic hexanucleotide repeat sequence in C9orf72. The recent C9orf72 breakthrough reinforces the concept that ALS is comprised of multiple, complex pathogenic pathways.10 This body of research highlights the need for the physical therapist to not only focus on assessment of the motor syst (...truncated)