The role of the dietitian is to devise an individual program to provide adequate nutrients in the context of the patient’s swallowing ability. ALS may cause weakness of the muscles involved in chewing and swallowing, which can result in coughing and choking episodes. The objective is to provide adequate nutrients while preventing aspiration of food or liquids into the lungs, which could lead to infection and pneumonia. This is typically accomplished by modifying the consistency and texture of foods and liquids or by recommending the use of alternative feeding methods.
The role of the speech-language pathologist is to assess the ALS patient’s speech and communication skills, implement strategies to enhance communication, provide patient/family and assure that ALS patients can express their feelings, thoughts, and needs. If there is muscle weakness in the lips, tongue, or palate, the patient may not be able to move their mouth precisely or fast enough, which results in slurred speech. Instruction in the use of compensatory strategies (such as slowing the rate of speech, separating the syllables, and over-enunciating the speech sounds) can be helpful. These strategies can also be augmented by communication devices such as magic writing slates, alphabet boards, picture boards, eye scanning boards, electronic devices with voice output, and even high-tech computerized devices.
The role of the social worker is to assess the impact of recent physical, emotional, and financial changes in the patient with ALS and how the patient and family are coping. Current and future needs are addressed, as well as the personal and community resources that may be available to help meet those needs.
The role of the respiratory therapist is to obtain measurements of respiratory function and instruct the ALS patient and family in the use of therapeutic measures such as breathing exercises and assistive coughing and in the use of equipment such as a breathing tube.
The role of the physical therapist is to assist the patient in the areas of
exercise, equipment, and safety. This includes patient and caregiver instruction in stretching and range of motion exercises to help maintain flexibility and reduce cramping. The physical therapist may also recommend devices and equipment such as an ankle-foot-orthosis, a cane, a wheelchair, a neck brace to help in maintaining mobility and independence. Instruction in proper methods for moving, transferring and lifting patients and recommendations for safety equipment including aids for transfers, lifts, grab bars and shower chairs are also provided. The goal is to promote the highest level of possible function, for as long as possible while avoiding fatigue.
The role of the occupational therapist is to provide the ALS patient with options, resources, and information for maintaining independence in activities of daily living. The occupational therapist assesses the patient’s functional abilities (range of motion, muscle strength, daily activity levels, and mobility) and performance in activity areas such as dressing, feeding, hygiene, and in the work environment. Adaptive devices such as rocker knives, button hooks, handwriting aids, book holders, zipper pulls, key holders, reachers and grab bars may be recommended to assist weakened muscles, reduce fatigue, promote safety, and enhance life quality.