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Rehabilitation Reference Center - Case Scenario #3 - ALS

Clinical Case Scenario #3

Long term Rehabilitation Plan: ALS

Clinical Scenario

Libby R., a 56 year-old woman is diagnosed with amyotrophic lateral sclerosis (Lou Gehrig’s disease). She has become progressively weaker and fatigued and she stumbles when walking. She is referred to the Rehabilitation Hospital for a multidisciplinary approach to long term management of the progressive disease.

Searching in Rehabilitation Reference Center (RRC)

Using Rehabilitation Reference Center, the physiotherapist, occupational therapist, and speech pathologist search ALS. From the Results List they choose the Clinical Review Amyotrophic Lateral Sclerosis (ALS) AN: 5000007561 and read about the characteristics of this progressive disease: muscle weakness, decreased strength, and safety challenges such as falls and choking. The rehabilitation goals are to maintain functioning for as long as possible and to protect Libby from complications, such as falls, pressure sores, and painful muscle contractures.

She will be taking Riluzone, an agent approved by the FDA for extending survival, or time to tracheostomy.

Clicking on Drugs in the Results List the rehabilitation nurse checks drug interactions and special instructions in AHFS Drug Information Essentials.

Libby will be cared for at home after a plan is developed which also includes a home exercise program, use of assistive devices for feeding, bathing and dressing, and a plan for eventual hospice care. These goals are consistent with the current American Academy of Neurology Guidelines in RRC.

Choosing the Assessment/Plan of Care Chart the therapists choose an exercise/maintenance care plan designed to conserve Libby’s energy over the next few months and beyond, and support her muscles and joints, for example range of motion exercises, transfer safety training with family members, and use of a motorized wheelchair.

Patient Education paper Amyotrophic Lateral Sclerosis AN: 2009543368 and Amyotrophic Lateral Sclerosis (Alternative Therapy) AN: 2009580554 are printed as well as several exercise images:

Activities of Daily Living:
     Energy Conservation, Mobility- Chair with Wheeled Base;
     Impaired Balance, Front Wheeled Walker;
     Transfer- Sit to Stand;

Pulmonary:
     Energy Conservation, Bathing