The Right Steps in ALS Treatment, What to Do, What Not to Do?
Interviewer (Mrs. Büşra): Hello Mr. Onur, we would like to better understand ALS disease and the place of physical therapy in this disease. What is ALS, how are patients affected by this disease?
Mon. Onur Aslan Hello, Ms. Büşra. ALS is a disorder that falls into the group of motor neuron diseases. Motor neurons are nerve cells that transmit signals from the brain and spinal cord to the muscles. In ALS, these cells start to lose their function and become unable to control the muscles. Over time, weakness, muscle thinning and loss of movement develop. However, there is a remarkable point here: ALS does not directly affect mental and sensory functions. In other words, the patient can fully perceive what is happening around him or her, but the physical limitation increases and makes life more difficult.
Ms. Büþra
What are the main challenges faced by ALS patients?
Mr. Onur Muscle weakness is one of the most prominent symptoms. Starting with hand and leg muscles, this weakness can affect speech, swallowing and even respiratory muscles. In the following period, the patient may almost completely lose mobility. This is why physical therapy comes into play as a very important support here. Physical therapy plays a critical role in preserving muscle functions, ensuring joint mobility and enabling the patient to lead a more comfortable life.
Ms. Büþra:
How does physical therapy contribute to ALS patients? At which stages should it be applied?
Mr. Onur The main goal of physical therapy is to preserve muscle function as much as possible and help the patient maintain independence as much as possible. We try to slow down the restriction of movement by exercising the muscles. In the later stages of the disease, even when movement capacity is very limited, passive movements are applied to maintain joint health. When the respiratory muscles need support, respiratory therapy can facilitate breathing by planning appropriate exercises. All of this is planned individually because each ALS patient has a different disease course.
Ms. Büþra:
What should ALS patients pay attention to during physical therapy? Are there things that should not be done?
Mr. Onur: Absolutely. First of all, patients should know their limits and avoid movements that are challenging and require excessive effort. It is our goal to ensure the patient's mobility and independence in the early period. It is important to conserve energy here, because overexertion can accelerate muscle loss. Therefore, exercises should be light and controlled. Exercises to support the respiratory muscles are of great importance, especially in advanced stages. It is also important to perform each movement correctly to ensure that the muscles work correctly.
Ms. Büþra:
Is electrotherapy for ALS patients the right approach?
Mr. Onur: One needs to be careful about this. Electrotherapy is a method used to stimulate muscles and relieve pain. However, such electrical stimulation may not always be recommended in progressive neurological diseases such as ALS. Excessive muscle stimulation can cause unnecessary fatigue in already weak muscles. If electrotherapy is to be used, it should only be administered under the advice and control of a qualified therapist. The decision should be based on the stage of the disease and the individual's muscular structure.
Ms. Büþra:
Dysphagia is common in ALS patients. What kind of treatment can be applied in this regard?
Onur Bey Yes, swallowing difficulties are quite common in the later stages of ALS. This can pose a serious risk to the patient's ability to eat safely and healthily. In swallowing treatment, exercises that support the swallowing process by targeting specific muscle groups are performed.
However, caution is needed with the use of electrotherapy agents in the treatment of swallowing. Electrotherapy is generally not recommended in ALS patients as it can cause rapid muscle fatigue and irreversible muscle loss. It is important not to strain the musculature and to avoid such treatment methods when supporting swallowing function. Instead, we prefer to proceed with less strenuous, manual swallowing exercises that safely support the muscles. The patient's sitting position and eating habits are also adjusted to reduce the risk of choking. In this process, it is important to create a swallowing treatment plan specific to each patient.
Ms. Büþra:
Apart from physical therapy, are there other approaches that can support ALS patients?
Onur Bey Yes, occupational therapy is a very important area for them to remain independent in their daily life activities. Even seemingly simple tasks such as dressing, eating or writing can become challenging for ALS patients, so supporting them in these areas improves their quality of life. Speech therapy can also be a solution to communication difficulties. Psychological support is very valuable for both the patient and their relatives. A supportive environment and strong psychological support are also very important to keep the patient's motivation and morale high.
Ms. Büþra:
What should patient relatives pay attention to during this process?
Mr. Onur The biggest task of the relatives is to respect the patient and be there for him/her without pushing him/her too hard. A strong support increases the patient's motivation. However, the more independent the patient can remain, the better; it is important to leave tasks that the patient can do independently, even if they are small things. Relatives also need to keep themselves psychologically strong. Because this is a long-term process and it can wear both the patient and their relatives down.
Ms. Büþra:
Do you have any other suggestions for ALS patients?
Mr. Onur: Absolutely. Although ALS is a neurological disease, one should be open to all kinds of support to maintain physical and mental balance. Staying connected to social life and keeping the circle of friends and family warm also positively affects the patient's morale and quality of life. Physical therapy is an indispensable part of this process and should be applied with expert support at every stage of the disease.