By Ivy Stites and Keya Patel Patient 005 By Ivy Stites and Keya Patel

Scenario Andrew, a 45 year-old single father of two, comes to you in confidence. He’s noticed that the muscles in his hands and feet have gotten progressively weaker lately, and from time to time, he sees these muscles twitch. He used to lift weights at the gym quite a bit, but he now has trouble lifting the bar. His daughter noticed that he seems to be tripping and stumbling quite often and commented that it took him quite a long time to get the key in the door the other day. Andrew claims that mentally he feels fine, but it’s almost like his muscles are slowly giving out on him. You don’t see any twitches going on right now, but you are having a hard time hearing him. He seems to be having trouble projecting his voice and his speech is slightly slurred at times.

Symptoms Muscle weakness in the hands and feet Muscle spasms Tripping and stumbling - cerebellum Disorientation Mild cognitive impairment Slurred speech Voice projection Motor Cortex Frontal lobe Broca’s area in left frontal lobe

Diagnosis Andrew was identified to have Amyotrophic Lateral Sclerosis (ALS) or Lou Gehrig’s Disease through use of symptoms and tests to rule out other diseases Neurological exams – muscle twitching and overactive reflexes; rules out any other neurological disorder; movement (LMN and UMN) EMG – used to measure nerve signals over time MRI – rules out spinal cord pressure Blood and urine test – used to find any other disease that has similar symptoms

Affected Areas in the Nervous System The axon of the motor neuron is affected by ALS. It doesn’t transport the entire message.

Prognosis Andrew will more than likely progress to Overactive reflexes Faintness Organ function impairment Loss of speech Paralysis Death

What is ALS? “A progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord.” It is 100% fatal. A new disease pathway was discovered in gene C9orf72 that damages DNA – partly discovered through the funds from the ALS Ice Bucket Challenge. 10% of cases are genetic.

Physical Therapist Physical Therapists help the ill with diseases improve courses of movement to help reduce or eliminate symptoms and diseases. Andrew had significant weakness and muscle tremors. A physical therapist in Andrew’s case can help him keep the movement in his body present, to keep his motor neurons alive and reduce severity of symptoms. Even though the physical therapist cannot make him move his muscles, they can work to salvage what is left and help Andrew fight the weakness he’s feeling.

Speech-Language Pathologist Some speech and language pathologists specialize in voice projection. Andrew speaks softly and doesn’t realize it. A speech pathologists could help him talk louder by continuous patterns in speech to help muscles to move. They could also refer the patient to a dentist to get a palatal lift to relieve pressure in the mouth.