ALS, Cancer, End of Life Issues – Flashcards
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Amyotrophic Lateral Sclerosis (ALS)-
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-Describes a group of progressive, degenerative neuromuscular diseases, no remission -Destruction of motor neurons within the spinal cord, brainstem & motor cortex -Rapidly progressive disease with life expectancy of 3-5 years after symptom onset -20-25% of people with ALS experience cognitive changes
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What are the similarities and differences between the other neurodegenerative diseases we have talked about (MS, PD, HD)?
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This is different than MS because this is a destruction of the connections vs. just an interruption; no remission; steady, rapid decline See this as fatal (like HD) rather than just living with a chronic, disabling disease (MS or PD) - changes life expectancy
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How would this affect your choice for intervention approach and interventions?
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Choose compensation/adaption/prevention/maintain rather than establish/restore
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Ideas for interventions - lots of overlap: ALS
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Acute care - immediate needs (remember information from GBS early stage) - call light/TV access, informing nurses about assistance with opening packages, transfers into cardiac chair to prevent pneumonia, referral for further services - HH, OP w/c, follow-up multidisciplinary clinic, match between client needs and caregiver services Multidisciplinary clinic - resources in community, full-time caregiver plans, adaptive strategies/equipment for eating, bathing, maintenance exercise program to maintain ROM, muscle strength (theraputty, theraband) OP wheelchair clinic - appropriateness for power wheelchair, adaptions to the chair Home health care - home modifications, bathroom DME, family training
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Intervention focuses based on disease process stage
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Early stage: low tech adaptations (button hook, built-up handles), maintenance exercises, energy conservation techniques Middle stage: bathroom equipment, caregiver training to provide assistance vs. maintain independence Late stage: transfers (hoyer lifts), splinting to prevent contracture, PROM At each stage consider (may change over time): participation in meaningful activities continued participation in roles transitioning roles quality of life, end of life issues
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Systematic Review - OT Related Interventions for People with ALS 5 categories of interventions
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- Exercise - Assistive devices & wheelchairs - Multidisciplinary programs - Palliative care - Preparatory methods
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Exercise- ALS
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-Individualized resistance exercise programs may help prolong functional independence -While muscle strength is not regained/improved, exercise programs can help maintain strength in unaffected muscles and preserve ADL independence -Personalized ROM programs are critical to prevent joint contraction
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What would be the intervention approach for exercise when working with clients with ALS?
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- maintain, prevent (as opposed to establish, restore)? How would this be different than someone with Guillain-Barre, non-traumatic SCI, stroke. For SCI, new research is treadmill locomotor recovery programs where they are bombarding the nervous system with input even if the person has no LB movement. Would this be appropriate for ALS patients? - no because prognosis drives intervention approach.
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Assistive Devices & Wheelchairs
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-Clients seem most interested in equipment that increases safety and independence with bathing and toileting -Bathroom DME (grab bars, raised toilet seats, shower seats) were rated as the most useful and satisfying equipment -Careful consideration must be made in selecting features of a power wheelchair, including client's changing needs throughout the disease process
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Why do students think clients with ALS would find bathroom DME useful and satisfying and rate other equipment as not? -
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looking for what makes easier/safer for caregiver, longer term perspective, dignity/privacy/personal nature of toileting/bathing.
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Multidisciplinary Programs
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Increase quality of life and length of survival OT brings unique perspective of helping people participate in activities and roles that are most important (energy conservation techniques, adaptations/modifications) OT can provide recommendations to optimize the environment (home modification, adaptive equipment/DME)
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Palliative Care
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Can provide a variety of interventions within the palliative care setting: - Positioning - Splinting to prevent contractures - Adaption for continued participation in meaningful activities - Education for caregivers and family
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Preparatory methods:
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Minimal evidence to support use of electrical stimulation to improve bilateral hand function and knee extension
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Areas for Future research
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Overall research on the effectiveness of ALS interventions is limited Potential areas for OT research Use of energy conservation techniques to improve function Impact of OT services on the quality of life for clients with ALS and their caregivers
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Cancer
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Broad grouping of diseases characterized by malignant tumor cells growing within the body Most common cancer in men & women is lung cancer; prostate cancer in men and breast cancer in women Cancer is described in stages in terms of the extent or progression of the cancer
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Phases of Cancer Recovery - Early Postdiagnosis Phase Intervention approaches:
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prevention, maintain, modify
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Early postdiagnosis phase symptoms: (OP)
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- impaired physical or psychosocial functioning - changes in employment status - difficulty in ability to rest
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Early postdiagnosis interventions:
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- education on energy conservation and activity management to order to meet occupational needs - training to prepare client for what to expect after surgery - advocate to ensure that individuals obtain the necessary rehab services
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Possible assessments: Early postdiagnosis
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Role Checklist, Occupational Questionnaire
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Phases of Cancer Recovery - Postoperative Phase Intervention approaches:
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prevention, maintain, modify
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Postoperative phase symptoms: (acute care setting)
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- frightened to move - difficult to move - movement restrictions - potential need for additional rehab
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Postoperative interventions:
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- follow post-surgical precautions/protocols (OOB to prevent deconditioning) - education on safe movement, adaptive equipment/techniques (temporary or permanent) - recommendations for discharge (further rehab or home)
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Possible assessments: Postoperative interventions:
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ADLs/FIM, Borg Scale of Perceived Exertion
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Phases of Cancer Recovery - Chemotherapy Phase Intervention approaches:
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prevention, maintain, modify
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Chemotherapy symptoms: (acute care or OP)
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- weakness & fatigue - limited ADL/self-care participation - bedrest - impaired sensation due to peripheral neuropathy - decreased FMC
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Chemotherapy interventions:
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- maintain activity tolerance (simple exercise & activity) - recommendations for adaptive equipment/techniques
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Possible assessments:
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Borg Scale of Perceived Exertion, Occupational Questionnaire, Interest Checklist, ROM/grip strength
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Phases of Cancer Recovery - Radiation Therapy Phase Intervention approaches:
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prevention, maintain, modify
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Radiation therapy symptoms: (OP)
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- difficulty remaining in specific place for radiation treatment - decreased movement due to burns
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Radiation therapy interventions:
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- molding body positions out of splint material - ROM to prevent frozen shoulder Possible assessments: ROM
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Phases of Cancer Recovery - Rehabilitative Phase Intervention approaches:
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restore, modify
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Rehabilitative phase symptoms: (rehab or OP)
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- decline in ADL independence - change in roles/routines - mild/moderate cognitive changes - swelling, lymphedema
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Rehabilitative phase interventions:
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- recommendations for return to meaningful activities and roles - interventions for lymphedema - recommendations for cognitive strategies
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Possible assessments: Rehabilitative phase:
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ACS, Occupational Questionnaire, Role Checklist, Interest Checklist, FIM, MOCA, Kettle test, EFPT
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Symptoms of Cancer Recovery - Pyschological/Emotional Symptoms Intervention approaches:
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prevent, maintain
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Psychological/emotional symptoms (all phases)
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fear, anticipation of pain, anxiety, stress depression longevity of the recovery process decreased socialization change in appearance
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Psychological/emotional interventions
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- coping strategies - interventions to regain/relinquish roles/routines - return to community participation
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Possible assessments: Psychological/emotional
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ACS, Role Checklist, Interest Checklist
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Symptoms of Cancer RecoveryLymphedema
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-Lymph nodes are removed, decreased transition of white blood cells -Leads to build-up of fluid -Lymphedema management - constant attention, massage, bandaging -Specialized certification
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Symptoms of Cancer Recovery - Lymphedema Intervention approaches:
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prevent, maintain
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Lymphedema symptoms (all phases)
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swelling change in appearance
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Lymphedemal interventions
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- bandaging/sleeves - retrograde massage Possible assessments: Circumferential measurements, volumeter
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Symptoms of Cancer RecoveryCognitive deficits
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"Chemo brain" Chemotherapy can affect many domains of cognition (mild/moderate declines) Affects areas: executive function, processing speed, attention, concentration, memory Often times not so severe that prevents participation in activities but compared to pre-cancer abilities, changes are evident
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Symptoms of Cancer Recovery - Cognitive Symptoms Intervention approaches:
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restore, modify
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Cognitive symptoms (all phases)
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- mild/moderate declines - affects areas: executive function, processing speed, attention, concentration, memory - comparison to pre-cancer abilities
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Cognitive interventions
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- adaptive strategies - cueing hierarchy - occupations/activities
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Possible assessments: Cognitive
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Kettle Test, EFPT, MOCA, Mini Mental, Dynamic Assessment of Categorization, SLUMS, ACL
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Holistic Perspective
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Physical - energy conservation, exercise to restore movement/strength, lymphedema management Cognitive - cognitive strategies for mild/moderate deficits Psychological - coping strategies, regaining or relinquishing roles/routines Social - returning to activity and community participation
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End of Life
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Encompasses both hospice and palliative care - directed at providing intervention services to those with life-threatening illnesses - focuses on symptom control and meeting the emotional, social, spiritual and functional needs of the client and family Hospice - further curative measures are no longer desired or appropriate - client has a life expectancy of 6 months or less Palliative care - initiated at any point in the course of the client's care - can receive curative services simultaneously
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Role of OT in end of life care
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Caregiver training (education & skills) Recommendations for appropriate equipment Promote quality of life through continued engagement in meaningful and purposeful occupations Help to determine priorities Most common intervention approaches: - compensation/adaptation/maintenance
