Amyotrophic lateral sclerosis: improving care with a multidisciplinary approach

Figures & data

Table 1 Multidisciplinary approaches to symptom management

Issue	Treatment options	Health care and support professionals involved
Disease progression	Riluzole	Neurologist/rehabilitation physician
Breathing difficulty	Assisted ventilation	Respiratory physician Respiratory therapist Nursing
Eating and drinking difficulties	Gastrostomy	Gastroenterologist Dietitian Speech pathologist Nursing
Saliva management	Medication	Neurologist/general practitioner/palliative care team
	Botox	Neurologist
Mobility	Mobility equipment	Physiotherapist Occupational therapist ALS association
Cognitive, behavior, and mood issues	Counseling and support for patient and family	Neuropsychologist Psychologist
Self-care	Assistive equipment	Occupational therapist Nursing ALS association
Communication	Alternative communication devices	Speech pathologist Occupational therapist ALS association
Grief and loss	Counseling and support for patient and family	Social worker Psychologist ALS association Palliative care team
Carer support	Counseling and support for patient and family	Social worker ALS association Palliative care team

Abbreviation: ALS, amyotrophic lateral sclerosis.

Figure 1 Development of a palliative approach in ALS.

Note: Reprinted from Lancet, 369(9578), Mitchell JD, Borasio GD, Amyotrophic lateral sclerosis, 2031–2041, Copyright (2007), with permission from Elsevier.²
Abbreviation: ALS, amyotrophic lateral sclerosis.

Figure 2 Involvement of palliative care in ALS and other neurological diseases.

Notes: (A) The traditional model of late involvement of specialist palliative services. (B) The model of early and increasing involvement of specialist palliative services. (C) The model of dynamic involvement of palliative services based on trigger points. Reproduced from Bede P, Hardiman O, O’Brannagain D. An integrated framework of early intervention palliative care in motor neurone disease as a model to progressive neurodegenerative diseases. Poster presented at: 7th European ALS Congress; May 22–24, 2009; Turin, Italy³⁵ which was originally adapted from Maddocks I, Brew B, Waddy H, Williams I, Palliative Neurology, Cambridge University Press, 2005.⁹⁸
Abbreviation: ALS, amyotrophic lateral sclerosis.

MitchellJDBorasioGDAmyotrophic lateral sclerosisLancet200736995782031204117574095

 PubMed Web of Science ®Google Scholar

BedePHardimanOO’BrannagainDAn integrated framework of early intervention palliative care in motor neurone disease as a model for progressive neurodegenerative diseasesPoster presented at: 7th European ALS CongressMay 22–24, 2009Turin, Italy

 Google Scholar

MaddocksIBrewBWaddyHWilliamsIPalliative NeurologyCambridgeCambridge University Press2005

 Google Scholar