Answer 5

  • Drop foot
    • Monitor ankle dorsiflexion strength 
    • Reassess by asking the patient if they have had any falls or near-falls.
      • May potentially get rid of the AFO if the patient finds that their strength is improving. However, as ALS is a progressive disease, it is unlikely that this patient would be getting rid of the AFO.
  • Shortness of breath on exertion
    • Use the MRC dyspnea scale. Educate the patient on using it whenever they are mobilizing and/or exercising. 
    • Reassess using MRC dyspnea scale or 6MWT or modified BORG scale when mobilizing
    • Modify treatment plan by changing mobilization distance, focusing on positions of ease, pacing education, and changing the gait aid. 
  • Right leg weakness
    • Use oxford scale for MMT.
      • As discussed, because ALS is a progressive disease, this patient is not likely to significantly improve so it is more important to manage the patient’s symptoms and ensure that preventative measures are taking place (ie. if the right leg is weaker, potentially add in a gait aid that is more supportive)
  • Deconditioning
    • Use the modified BORG scale to monitor symptoms. Educate the patient on using it whenever they are mobilizing and/or exercising. 
    • Reassess by using the modified BORG scale or by using 6MWT. 
    • Modify treatment plan by changing mobilization distance, focusing on positions of ease, pacing education, and changing the gait aid. 
  • Respiratory Complications
    • Monitor respiratory complications by measuring the patient’s peak flow. 
    • Modify treatment by ensuring that they have the supports that they need (ie. refer to respiratory therapists if they need oxygen therapy, cough assistance, etc.)