Clinically Speaking

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 Sclerosis (ALS).

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 seat cushion.

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 and comfort.

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 functional position.

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 and comfort.

This article originally appeared in the Seating & Positioning Handbook: March 2010 issue of Mobility Management.