Stages of ALS

Phase Stage Patient Characteristics Intervention

Phase I: Stage Mild weakness Energy conservation

Independent I Clumsiness Range-of-motion (ROM) and
Able to ambulate Gentle resistance exercises
Independent in ADLs Psychological support

Stage Adaptive equipment for ADL

II
Moderate weakness, such as
difficulty raising arm overhead
Slightly decreased independence in
ADLs
Begin use of hand orthosis to
orthosis (AFO), wrist support
Continue ROM and stretching
May continue strengthening p
overwork fatigue

Stage Severe weakness, especially in the May benefit from manual or

III ankles, wrists, and hands support
Moderately decreased independence Work simplification
in ADLs Energy conservation
Easily fatigues walking a long Activity planning and prioriti
distance Adaptive equipment
Slight increase in respiratory effort Adaptive communication
Explore possible alternative e
Home modifications
Deep breathing exercises

Phase II: Stage Hanging-arm syndrome, which May need arm slings or mobi
Partially IV includes shoulder pain and hand May benefit from a power wh
Independent edema Assistive technology
Wheelchair dependent Environmental control
Severe lower extremity weakness Voice-activated compu
Can still perform some ADLs but Augmentative commun
may fatigue easily Wrist and hand splints
Management of pain and mus
Heat and massage
Antiedema measures
Active assist ROM (AA
(PROM) exercises for w
Isometric exercises
Client and family education o
shoulder

Stage Severe lower extremity weakness Patient, family, and caregive

V Moderate upper extremity weakness How to provide assistan
Wheelchair dependent Provide techniques to m
Increasingly dependent in ADLs Body mechanics
I bilit diffi lt ith i ht U f h i l lift