Many of us have had some interaction with a physical therapist (PT) at some point in our lives. Odds are you’ve had a sprain, strain, or something that needed some help to heal correctly. To make sure that happened, your doctor prescribed a few sessions with a PT to make sure you were doing your exercises, and doing them correctly.
But for people living with ALS, the PT’s role as part of a multidisciplinary care team is more extensive, and ongoing. PTs help people maintain as much independent function as possible throughout the disease to improve overall quality of life. They assess a person’s ability to safely handle everyday movements like walking, standing and even sitting, and help maximize strengths and address movement challenges through physical activity and exercise, movement-specific functional training and equipment adaptations.
Just as important as the “what” of the PT’s job is the “how.” They spend time talking and listening to people with ALS and their families about their wants and needs on an ongoing basis, assessing how the family can help the individual move to ensure both they and family are safe and efficient.
As part of the multidisciplinary team, PTs will also work closely with the occupational therapist to help implement movement solutions, the respiratory therapist to coordinate breathing exercises, and the social worker on referrals for needed equipment. “Communication and collaboration is the cornerstone of what makes a clinic work,” said Elissa Held Bradford, a physical therapist for the ALS Certified Center of Excellence at Saint Louis University.
The PT will also reinforce that at the right dose, exercise can be part of the comprehensive treatment plan for people living with ALS. Range of motion and stretching exercises are recommended for all individuals with ALS. Light to moderate intensity aerobic and resistance exercise of muscle groups that can move against gravity is also recommended for those in the early to mid-stages of ALS.
The goal is to maintain as much strength and endurance as possible for as long as possible, but not overdo it and potentially increase weakness. “In a disease that typically results in the loss of strength and endurance, maintaining or slowing loss, is a gain,” Bradford said.
One of the biggest challenges for people with ALS is the changing nature of the disease over time. Symptoms may appear gradually over time, or they may occur rapidly and then plateau. The PT works with their patients and families to both focus on the present while also thinking ahead about interventions that might be needed in the short and long term. “I find those that can do this—staying active and living their present best life—while simultaneously looking cautiously ahead to plan for what may be, adapting as they go, report the highest quality of life,” Brandford said.
It is important to note that while the types of challenges the PT will address as ALS progresses might change, their core role does not: maximizing movement abilities throughout the journey and helping people do the things they value the most, even if that means doing them differently.
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