Question 1

Which approach needs to be considered when determining the appropriate amount and type of exercise in a patient with amyotrophic lateral sclerosis whose functional status has declined?&#10;A)Encouraging the patient to rest and exercise less so energy can be conserved&#10;B)Providing a program that includes exercises with heavy eccentric loading&#10;C)Developing a program that focuses more on the weaker muscles versus the stronger ones&#10;D)Providing the patient with an exercise program at moderate to low intensities

Accepted Answer

Providing the patient with an exercise program at moderate to low intensities is the appropriate approach for a patient with amyotrophic lateral sclerosis whose functional status has declined. High-intensity exercise can cause muscle damage in these patients, so a low-intensity, moderate-volume exercise program can help maintain function without causing further damage. It is also important to consider the patient's individual abilities and limitations when developing an exercise program.

Question 2

A patient who was recently diagnosed with amyotrophic lateral sclerosis presents with clonus and weakness in the right dorsiflexors (3/5)and hip flexors (4-/5).The patient also reports a few choking episodes when eating.Which is the MOST appropriate category for this patient according to the El Escorial Criteria?

A)Clinically probable
B)Clinically definite
C)Clinically possible
D)Clinically probable with laboratory support

A

Accepted Answer

The El Escorial Criteria for ALS diagnosis requires evidence of upper and lower motor neuron signs in multiple regions. The patient's symptoms suggest upper motor neuron signs (clonus) and lower motor neuron signs (weakness) in multiple regions, fitting the "clinically probable" category.

Question 3

A patient with amyotrophic lateral sclerosis is unable to elevate the eyebrows.Which cranial nerve (CN)is MOST likely involved?&#10;A)CN V&#10;B)CN VII&#10;C)CN IX&#10;D)CN X

Accepted Answer

The ability to elevate the eyebrows is controlled by the muscles innervated by the facial nerve (CN VII). ALS is a progressive neurological disorder that affects the motor neurons controlling voluntary muscles, including those supplied by the facial nerve. Therefore, the inability to elevate the eyebrows is most likely due to involvement of CN VII.

Question 4

A patient reports difficulty with holding eating utensils and writing but denies difficulty when using the left hand.Upon physical examination,fasciculations and a positive Babinski sign are noted in the right upper extremity.Which of the following is the MOST likely diagnosis?

A)Acute poliomyelitis
B)Charcot-Marie-Tooth disease
C)Guillain-Barré syndrome
D)Amyotrophic lateral sclerosis

Accepted Answer

The symptoms of difficulty with holding utensils and writing, along with fasciculations and a positive Babinski sign in only one upper extremity, suggest a diagnosis of amyotrophic lateral sclerosis (ALS). ALS is a progressive neurodegenerative disease that affects both upper and lower motor neurons, leading to muscle weakness and atrophy. Fasciculations and positive Babinski sign are specific findings in ALS. Acute poliomyelitis, Guillain-Barré syndrome, and Charcot-Marie-Tooth disease can also present with muscle weakness but are less likely to cause fasciculations and positive Babinski sign in only one upper extremity.

Question 5

A 56-year-old patient with amyotrophic lateral sclerosis reports mild to moderate right shoulder pain that has been getting worse over the past 3 weeks.The strength of the shoulder musculature is 4/5.Which of the following is the MOST appropriate intervention at this point in time?

A)Performing heavy eccentric exercises to maintain stabilization
B)Providing the patient with a sling to allow his shoulder to rest
C)Managing pain and advancing to moderate resistance exercises
D)Using modalities for pain relief

Accepted Answer

Managing pain and advancing to moderate resistance exercises is the most appropriate intervention at this point in time because it will help to maintain the strength of the shoulder musculature and improve the patient's range of motion.

Deck 17: Amyotrophic Lateral Sclerosis