The degeneration of upper motor (UMN) and lower motor (LMN) neurons, leads to progressive weakness of bulbar, limb, thoracic and abdominal muscles (Andersen and others 2007) causing muscle weakness, stiffness and immobility.
Assessment and continuing review by physiotherapist and occupational therapist for:
- management of exercise, positioning and pain
- prescription of appropriate equipment and aids to assist independence, mobility and comfort (MND Australia 2011)
A common question of physicians and patients is the effect of exercise on ALS/MND. There are theoretical reasons to suggest that excess exercise may be deleterious to compromised motor nerves and muscle, but equally there are the normal benefits of exercise on nerve and muscle growth and sustainability (Orrell 2010).
Pain and discomfort in MND arise as complications of muscle weakness, stiffness and immobility. Pain from pre-existing conditions such as arthritis may be exacerbated by muscle wasting (MND Australia 2011).
Consultation by a palliative care physician and/or team can be helpful in the assessment and management of pain.
Muscle cramps are more common early in the disease course. There is insufficient data to support or refute any specific intervention for the treatment of cramps in ALS (Miller 2009b).
Anti-spasm drugs are well worth considering in the treatment of MND. However, it must be stressed that careful assessment of the effect of spasm medication is essential. Coordination with a physiotherapist is essential to determine the relative role of medication and regular physiotherapy e.g. passive stretching of limbs. Advice should be sought from the physiotherapist regarding optimal positioning in bed and chair. (MND Australia 2011).
