Considerations for Patients Diagnosed with ALS
- By Megan Kutch
- Mar 01, 2010
Rehab professionals must account for a great number of
considerations to match a patient to the proper mobility
equipment that will deliver the best outcome. The factors
that must be accounted for grow considerably when a patient
has a progressive diagnosis, such as Amyotrophic Lateral
By examining and understanding what considerations need
to be made during the evaluation process, we can make a major
impact on the quality of life of a patient with ALS.
The Initial Evaluation
During the evaluation process, it is critical to determine what
current seating and positioning needs your patient is experiencing.
However, since this diagnosis progresses quickly, you
also have to supply them with a base and a seating system that
have the ability to adapt to meet their future needs.
You will need to focus on your patient’s functional abilities,
environmental considerations, home accessibility and transportation,
as the goal is to provide them with a solution that helps
them complete their activities of daily living (ADLs) even as
their condition progresses.
It is important to be up front with your patient and their
spouse or caregiver: Explain how ALS typically progresses
and how this progression can impact their equipment
requirements. For example, if your patient is in the early
stages of ALS and is just starting to experience fatigue
or have difficulties with their ADLs, they may feel more
comfortable in a captain’s or high-back style of seat. You will
need to discuss the different types of seating and positioning
components that will be needed in the future so they can
better understand, and become more involved in, the process
of finding the correct power base solution.
You should explain why a power base that has the ability to
accept power positioning options and upgraded electronics, and
that is oxygen and vent compatible, is necessary to meet their
long-term needs. By initiating this dialog in the evaluation, you
are ensuring that you, the patient and the caregiver are all on
the same page moving forward.
Seating & Positioning
Proper seating and positioning is extremely important for
the overall well-being of your patient. The main goals are to
maximize function and mobility, prevent deformities, increase
comfort, manage tone and provide optimal stability. Putting
your patient in the wrong seated position can lead to numerous
problems, including difficulties with breathing and digestion,
along with the possibility of developing skin breakdown or contractures.
Whether you provide a static
seating system or a power positioning
system, what you recommend
for your patient must have
the ability to grow in both seat
width and depth to accommodate
for any physical changes
that may occur. You should also
consider that you may need
to add a power elevating seat,
power articulating foot platform
or power articulating legrests
in order to provide them with
optimal positioning and maximize
their comfort. You should
review the seat-to-floor height of
the seating system that you will
be providing on the power base.
Seating and positioning components such as cushions and
backs are vital to the health of a patient with ALS. If funded
through Medicare, the type of seat cushion used depends on the
patient’s diagnosis. ALS patients will qualify for a skin-protection
The seat back that is selected for the patient should help to
compensate for postural asymmetries and provide comfort.
This backrest should also have built-in lateral thoracic supports
or the ability to accept lateral thoracic supports that may need
to be added as the patient’s illness progresses. There is a variety
of seat cushions and backs manufactured that meet the abovementioned
criteria and provide pressure distribution, stability
When discussing seating and positioning, the first things that
usually come to mind are seat cushions, backrests and power
positioning. However, to a patient with ALS, other positioning
components are just as crucial.
Providing a client with proper and functional head support
and comfort can truly assist with determining the other positioning
needs for the patient. There are numerous headrests that
can be prescribed to support and align the head in a stable and
Your patient may also benefit from additional positioning
components such as pelvic belts, chest harnesses, lateral
pelvic thigh supports, arm troughs, palm extensors, gel arm
pads, elbow supports or foot boxes. In many cases, a patient’s
functional ability is largely determined by their positioning
This article originally appeared in the Seating & Positioning Handbook: March 2010 issue of Mobility Management.
Megan Kutch, MS, OT, is the Quantum sales manager for Pride Mobility Products Corp., Exeter, Pa. Megan can be reached via e-mail at firstname.lastname@example.org or by calling (800) 800-8586.