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Amyotrophic Lateral
Sclerosis
Presented by
Professor Kathy Mitchell
Algonquin College
Ottawa Ontario Canada
COURSE CONTENT
1. What is ALS
2. Community Resources
3. Health care team
4. Assessment of client’s needs
5. Physiological and Psychosocial needs
6. Managing the illness at home
7.Ethical issues and decision making
8.Research and hope for the future
ALS
Lou Gehrigs’ disease-June 2 1941-United States-age 37
Motor Neurone Disease-Europe
Maladie de Charcot -1840
ALS
Progressive degenerative neuromuscular disease
Attacks motor neurons which control voluntary muscles-movement of arms legs
Muscles used in swallowing, breathing and talking
Does not affect: Cognitive status
Vision and eye movement
Sensory system
Bowel/bladder/sexual function
Types
Sporadic-90-95%
No family history
Familial-5-10%
Adult Familial-gene defect on chromosome 21
20% have deficiency of SOD1-super oxide dismutase enzyme
Physiology
No known cause or cure
Not contagious or infectious
Age dependent-80% of all cases between 40-70
Life expectancy 18 months-5 years
Men 1.5 ratio to 1.0 women
Diagnosis
Done by excluding other illnesses
El Escorial ALS diagnostic criteria
History, Physical , Neurological exam
Signs of upper or lower motor neuron degeneration with progressive spread
Clinical symptoms
Muscle weakness
Muscle atrophy
Shortness of breath
Slurred speech
Occasional choking
Limb Onset
Weakness
Fasciculations-involuntary muscle twitches
Atrophy-muscle deterioration
Dysarthria-inability to articulate words
Respiratory impairment
Progressive muscular weakness
Bulbar onset
Speech disorder-weakness in tongue,jaw lips-dysarthria
Difficult swallowing-dysphagia
Respiratory problems-dyspnea
Excessive salivation-sialorrhea
Fatigue
Disease Progression
Client specific- Length of illness unpredictable
Paralysis of voluntary muscles
Atrophy
Cause of death-respiratory failure
Interdisciplinary Team
All team members contribute from their own professional expertise to support the client and family
Nursing Model of Assessment is based on the work of Calista Roy
Health Team
Person with ALS
Family
Physician/physiatrist
Registered Nurse
Physiotherapist
Occupational Therapist
Speech Therapist
Nutritionist
Health Team
Social Worker
Pastoral care Worker
Home Care worker
Community based care-mobility
Respiratory Therapist
Palliative care
Holistic Care
Disease progress is unpredictable
Continuous assessment, implementation and evaluation of needs of client and family
Communication with health care team is ongoing
Physical and psychosocial needs create major challenges
Physiologic Needs
Oxygenation
Nutrition
Fluids and electrolytes
Elimination-Bowel and Bladder
Activity and Rest
Protection
Psychosocial Needs
Self concept
Role function
Interdependence
Current Treatments
Home care based
Long term management of client problems
Medication-to alleviate symptoms
Physical therapy-maximize capabilities
Speech therapy augmented communication
Nutrition-p.e.g. tube
Ventilation-non-invasive vs invasive
Hope for the Future
Longer prognosis
Live beyond five years
Physical impairment will move slowly
Assistive devices will maintain independence
Minimum of suffering
Drug therapy will progress-Riluzole
Effective symptom management
Hope for the Future
Positive attitude
Firm belief system
Support of family and friends
Spirituality
Hiroshi Mitsumoto Columbia University
Спасибо доктору Льву Брылеву и Фонду «Живи Сейчас»!
Contact details Ottawa
Kathy Mitchell R.N. B.N.
613 727-4723 ext 5389
www.algonquincollege.com
Email: mitchek@algonquincollege.com
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