Amyotrophic lateral sclerosis (ALS) is a rare neurological disease that is characterized by the deterioration of the nerve cells that control voluntary muscle movement, known as motor neurons. At this point, there is no cure for ALS. However, a number of drug and non-drug related therapies can be used to improve the quality of life and survival in patients with ALS.
In particular, there are several non-drug therapies for ALS including, but not limited to, physiotherapy, occupational therapy, speech therapy, nutritional support, psychological and social support, acceptance and commitment therapy (ACT), and cognitive behavioral therapy, that can be beneficial to patients with ALS.
Here is a list of non-drug therapies that can help patients with ALS:
- Physiotherapy refers to the treatment of a disease or injury through the use of physical methods such as exercise.
- Physiotherapists can work with patients to help them build and maintain muscle mass and strength, help delay disease progression and retain the ability to conduct daily tasks.
- Physiotherapists can help design an individualized exercise regimen that will work the specific group of muscles that are being deteriorated to help patients stay independent and mobile for longer. The regimen will include stretches, range-of-motion exercises, and strengthening exercises.
- Physiotherapists will also work with caregivers to teach them how to assist the patient in their exercise regimen.
- The goal of physical therapy is to keep muscles strong and working as long as possible.
- Occupational therapy is defined as a type of therapy that helps rehabilitate patients that suffer from an illness by helping perform activities that are required in daily life.
- Occupational therapists help patients with different everyday needs such as walking, dressing, or brushing their teeth.
- Occupational therapists often work alongside physiotherapists for optimal results.
- Occupational therapists can also help the patient obtain adaptive or assistive devices (such as walking canes, wheelchairs, and orthotic devices) to help them maintain mobility. They can also teach patients how to use these tools correctly.
- Occupational therapists will also teach caregivers how to best assist the patient with daily tasks.
- Speech therapy is defined as training people with speech and language problems to speak more clearly.
- As ALS patients develop issues with speaking, speech therapists can help patients exercise the muscles that are involved in speech, such as those in their face, jaw, and throat.
- Speech therapists can also teach patients strategies to minimize issues with swallowing. For example, use of the chin tuck (swallowing in a head-down position) helps reduce the risk of choking and coughing.
- Speech therapists can recommend a variety of different devices and changes to diet that can help patients as they progressively lose functioning of their mouth muscles.
- While there are a lot of different types of equipment available for communication purposes (such as computers), weakness of the hands can often limit choices for patients. Speech therapists can recommend the best devices based on the patient’s condition.
- Speech therapists can help patients use non-speech based communication, such as gestures or eye movements, to communicate as patients progress to the advanced stages.
- Speech therapists are particularly important for patients that have the bulbar form of ALS (which affects the muscles of the head and neck first).
- Speech therapists can work with caregivers and families to learn techniques that convey the most amount of information with the least effort.
- Nutritional support in ALS is important as patients will start to experience difficulties chewing and swallowing early in the disease. Both liquids and dry foods will eventually become difficult to swallow.
- Patients will require frequent meals that provide high levels of energy but that are presented in a form that is soft enough so that there are minimal swallowing issues.
- Most patients will need a team composed of caregivers, a nutritionist and a speech therapist to help provide food that is adequate nutritionally, appetizing and manageable for the patient to swallow.
Psychological and social support
- ALS patients will often require a team of professionals composed of a social worker to help with financial issues, insurance, and helping obtain equipment and paying for assistive devices that are needed.
- ALS patients also require emotional support, which can be aided by psychologists, social workers, and caregivers.
Acceptance and commitment therapy (ACT)
- ACT is focused on helping patients accept the hardship and emotions that result from a diagnosis such as ALS.
- ACT is a type of mindfulness-based therapy, which theorizes that greater well-being can be obtained when a person overcomes negative thoughts and feelings.
- The goal of ACT is for the patient to learn and commit to utilizing new thought patterns and behaviors that can let the patient live their life in accordance with their values and goals.
Cognitive behavioral therapy (CBT)
- CBT is another form of psychotherapy in which a therapist works with a patient to overcome negative patterns of thought about themselves and the world in order to change unwanted behavior patterns or treat mood disorders such as depression and anxiety.
- Studies have shown that CBT helps improve quality of life for patients with ALS.