New Guide Provides Information on Benefits of Multidisciplinary Care for ALS Treatment

A new guide outlines the benefits of a multidisciplinary team approach to provide the integrated medical and mental treatment that amyotrophic lateral sclerosis (ALS) patients often need.

The guide, titled “A Guide to Understanding the Benefits of a Multidisciplinary Team Approach to Amyotrophic Lateral Sclerosis (ALS) Treatment,” was published in the journal Archives of Physical Medicine and Rehabilitation.

Because ALS symptoms affect every patient differently, treatment typically requires several different types of health care providers with diverse and specialized skills and knowledge. Instead of patients and their caregivers struggling to balance appointments and recommendations from several specialty providers, many hospitals and clinics are now providing multidisciplinary teams who work together to improve care for both patients and caregivers.

This approach may help lower a patient’s stress levels related to having to visit multiple health care providers. Studies have shown that multidisciplinary teams improve ALS patients’ quality of life, mental health, social functioning, and survival.

These teams may be composed of a neurologist, physiatrist, and physical, occupational, respiratory and speech therapists, as well as a dietitian, neuropsychologist, nurse, and social worker. If needed, home health care providers, and medical equipment and assistive technology specialists may also be available.

The team usually meets before and sometimes after the patient’s arrival to design and implement a personalized treatment plan.

On the team, the neurologist oversees and manages the treatment plan, adjusting it when necessary. The physiatrist focuses on maximizing the patient’s physical capabilities, which may require equipment and adaptive devices, such as manual or power wheelchairs, braces, or shower seats.

Physical and occupational therapists aim to help patients stay independent for as long as possible, providing education, specialized exercises, and equipment to improve walking, balance, and moving around at home and in the community. They also may help improve activities such as eating, bathing, toileting, and dressing.

The team also includes a pulmonologist and respiratory therapist to help maintain respiratory independence. Changes in breathing during regular movement or daily activities should be reported to these providers.

A dietitian and gastroenterologist provide nutritional support and weight management, which is associated with ALS progression. They provide diet guidance to ease swallowing and can address feeding tube placement, if needed.

Speech therapists analyze and monitor swallowing and speech production. They work with the dietitian and use compensatory speech approaches and devices to help with communication. The patient should discuss with these providers issues related to changes in speech, alternative communication methods, and feeding tube placement.

A neuropsychologist provides mental health support for both the patient and the caregiver, and helps with possible mood or cognitive changes.

Nurses help to carry out the treatment plan and provide integrative care to improve the patient’s overall health. They also act as a liaison between patients and medical providers, and can answer questions on medication use and side effects.

Social workers provide education and counseling on financial issues, insurance, transportation, employment, home-care, and community resources and programs.

In the U.S., many hospitals, Veterans Affairs medical centers, and health care facilities offer multidisciplinary care, some of which operate on a full-time basis, while others are on a specific schedule.

For more information on specialty clinics and low- or no-cost medical equipment, visit the websites of the ALS Association, the Muscular Dystrophy Association, Project ALS, the ALS Therapy Development Institute, and the ALS fact sheet from the National Institute of Neurological Disorders and Stroke.