Maintaining Quality of Life

Abstract

To the Editor: I am writing in response to the case report by Dal Bello-Haas et al entitled “Physical Therapy for a Patient Through Six Stages of Amyotrophic Lateral Sclerosis” (December 1998). My compliments to the authors for writing and the Journal for publishing this report, which gives an overview of the diagnosis, examinations, and interventions for the individual with amyotrophic lateral sclerosis (ALS). The rehabilitation community too often neglects our patients with deteriorating pathologies. I want to comment on 3 concerns regarding this publication. The first concern relates to the prescribed exercise protocol for the patient with ALS. The prescribed exercise program included 10 minutes of cycling at 65% of the maximal heart rate 2 times a day in addition to stretching activities and an active resistance exercise program for the lower extremities. The patient was to exercise for 2 20-minute sessions a day, and the exercise prescription was continued even after her second visit to the clinic, during which she showed a decrease in muscle strength in all groups tested. The authors cite only 2 references that addressed the effects of resistive exercise for the person with ALS, one being a 1983 case study, and admit that there is no evidence of “functional change from a resistive exercise program.” At our clinic, we support Sinaki, who does not advocate “any vigorous exercise programs for persons with ALS” but rather feels that “everyday activities are enough.”1 Our patients and their caregivers are taught a range-of-motion/stretching program to be performed daily, but active-resistive or aerobic exercises are done only through functional tasks that are valued by the individual patient. Our patients who are golfers are taught how to modify their golf games, and those who enjoy walking go to the malls in the summer and decrease their target …