Question

A client was diagnosed with amyotrophic lateral sclerosis. She lives at home with her husband. Her daughter and grandson live nearby. The client has a manual wheelchair. She stated that it was getting harder for her to move around and transfer in and out of the wheelchair. She also said that she finds it frustrating that she cannot shower or dress herself like she did a month ago. She needs more help from her family. During the evaluation, the OTR finds that the client has 2/5 muscle grade in the shoulder and 1/5 muscle grade in the wrists and hands. Which intervention activity would be MOST beneficial for this client at this stage?

1) Caregiver education
2) Energy conservation
3) Wheelchair evaluation
4) Strengthening program

Answer 1

For a client with amyotrophic lateral sclerosis, the most beneficial intervention is a wheelchair evaluation, in conjunction with caregiver education and energy conservation techniques. Strengthening programs are less effective due to ALS's progressive nature.

Step-by-step explanation:

The most beneficial intervention activity for a client with a diagnosis of amyotrophic lateral sclerosis (ALS), who is experiencing a decline in muscle strength and motor abilities, would be a wheelchair evaluation. Given the client's muscle grade of 2/5 in the shoulders and 1/5 in the wrists and hands, strengthening programs are unlikely to be effective due to the progressive nature of ALS, which leads to motor neuron degeneration and muscle atrophy. Caregiver education on proper techniques for transferring and positioning, as well as advice on adaptive equipment, can be a part of this intervention for both the client's safety and comfort.

Moreover, energy conservation techniques should be taught to allow the client to maintain independence for as long as possible while minimizing fatigue. Understanding how to manage daily activities with less exertion is crucial for quality of life. This education can also extend to the family, who will better understand how to support the client's needs.

ALS is known to degenerate motor neurons that control voluntary muscle movement. Over time, this leads to increasing muscle weakness and loss of voluntary control, ultimately resulting in paralysis. While muscle tone may be present initially, as the disease progresses, voluntary movement declines, and comprehensive approaches like wheelchair assessment and caregiver support become essential.