Marian Arbesman, Kendra Sheard; Systematic Review of the Effectiveness of Occupational Therapy–Related Interventions for People With Amyotrophic Lateral Sclerosis. Am J Occup Ther 2014;68(1):20-26. doi: 10.5014/ajot.2014.008649.
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© 2019 American Occupational Therapy Association
We describe the results of a systematic review of the literature on occupational therapy–related interventions for people with amyotrophic lateral sclerosis (ALS). The review included 14 studies. We found limited to moderate evidence that people involved in multidisciplinary programs have longer survival than those in general care and limited evidence that those in multidisciplinary programs have a higher percentage of appropriate assistive devices and higher quality of life in social functioning and mental health. Limited evidence indicates that people with ALS are satisfied with the comfort and ease of use of their power wheelchairs (PWCs). In addition, limited evidence is available that PWCs allow people to have increased interaction in the community. Evidence also is limited that some assistive devices are more helpful than others. Moderate evidence indicates that a home exercise program of daily stretching and resistance exercise results in improved function. The implications for practice, education, and research are discussed.
Limited to moderate evidence is available that participants in multidisciplinary programs have longer survival rates than those in general care, and limited evidence indicates that they have a higher percentage of appropriate assistive devices and higher quality of life in social functioning and mental health. Occupational therapy practitioners are uniquely qualified to help people with ALS make wise choices of equipment and environmental modification with consideration of the disease progression. A multidisciplinary clinic setting allows occupational therapy practitioners to work with the team to assist the client and family in setting goals and making choices that are client centered and allow engagement in desired roles and activities.
Limited evidence indicates that some assistive devices are more helpful than others. Bathroom equipment is especially helpful for people with ALS. The most helpful equipment includes raised toilet seat, shower seat or tub bench, grab bars, and bidet.
Evidence is limited that people with ALS are satisfied with the comfort and ease of use of their PWCs. In addition, evidence is limited that PWCs allow the person to participate in community-based activities. PWC features must be selected with the progression of the disease in mind. Some important features for this client population include headrest, padded full-length armrests, recline, tilt in space, elevating leg rests, caregiver controls, and the ability to modify wheelchair controls.
Moderate evidence indicates that a home exercise program of daily stretching and resistance exercise results in improved function. Daily range of motion—particularly for weakened muscles—is important for maintaining joint mobility and preventing contractures.
Although the evidence is limited, research indicates that occupational therapy is part of the palliative care team for people with ALS, even immediately before death. The course of ALS provides distinct opportunities for occupational therapy practitioners to be involved in the nontraditional practice areas of palliative and hospice care. Practitioners can address positioning and seating needs for people with ALS and train family members and hospice aides to provide an individualized range of motion exercise program.
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