Is there an ALS-specific physiotherapy?

Physiotherapy specifically for people with ALS has not been established. The relative rarity of ALS and the complexity of the symptoms are reasons why there is no “therapy standard” for treating people with ALS. There are two special features of physiotherapy for ALS patients that pose a particular challenge for therapists: The disease is progressive and therefore changing. The treatment goals and therapy techniques change as the disease progresses. While activating and function-preserving treatment goals are in the foreground at the beginning of the disease, passive mobilization (movement of the extremities in the joints and stretching exercises by the therapist) or symptom relief (relaxation of spastic muscles) are important as the disease progresses.

The change in treatment requirements during the course of the disease is a significant difference to a large number of other neurological diseases in which motor deficits develop acutely and regress (e.g. after a stroke) or experience a slow progression (e.g. in Parkinson’s disease). The dynamic nature of ALS makes it necessary to continuously review and adapt the treatment goals and forms of therapy. Another special feature of ALS is the combined damage to the first and second motor neurons. The degeneration of the first motor neuron is associated with spasticity (increased muscle tension), so that physiotherapeutic spasticity therapy becomes necessary. This therapy is very similar to the treatment of stroke and multiple sclerosis, which are also associated with damage to the first motor neuron. In contrast to spasticity, damage to the second motor neuron leads to a decrease in muscle tension and strength, so that activating physiotherapy is required in this situation (stimulation of the muscles to prevent atrophy of inactivity).

The challenge for physiotherapists lies in differentiating between symptoms of the first and second motor neuron and applying the appropriate physiotherapy. For example, there may be predominant damage to the second motor neuron in the upper extremities (with muscle atrophy and paralysis), which requires activating physiotherapy, while the lower extremities of the same patient may be dominated by spasticity, which requires muscle-relaxing therapy. Due to these special requirements for physiotherapy in ALS, it is desirable that therapists with special experience of neurological patients take over the treatment.