Unit 15
Lou Gehrig’s Disease (ALS) Overview
Lou Gehrig’s disease, also known as Amyotrophic lateral sclerosis (ALS), is a progressive neurological disorder that affects the motor neurons responsible for voluntary muscle movement. It is named after the famous baseball player Lou Gehrig, who was diagnosed with the condition in 1939. In ALS, the motor neurons gradually deteriorate and die, preventing the brain from sending signals to the muscles. As a result, muscles weaken, shrink (atrophy), and eventually lose function. While physical abilities decline, cognitive function and awareness are usually preserved, meaning residents are often fully aware of what is happening to their bodies.
Signs and Symptoms
Early signs and symptoms of ALS typically include muscle weakness in the hands, arms, or legs, frequent tripping or falls, difficulty grasping objects, muscle cramps or twitching (fasciculations), and slurred speech. As the disease progresses, symptoms worsen and may include significant muscle atrophy, difficulty speaking clearly (dysarthria), difficulty swallowing (dysphagia), drooling, shortness of breath, loss of mobility, and eventually paralysis. Because swallowing and respiratory muscles are affected in later stages, residents are at high risk for choking, aspiration, and respiratory complications. Importantly, ALS does not usually affect memory, thinking, or the senses.
CNA Role in Promoting Safety
The CNA plays an essential role in promoting safety and comfort for residents with ALS. Due to muscle weakness and balance issues, fall prevention is critical. CNAs should ensure the call light is within reach, pathways are clear of clutter, beds and wheelchairs are locked, and non-skid footwear is worn. Assistance with transfers and ambulation must be performed carefully and without rushing, using gait belts or mechanical lifts according to the care plan.
As swallowing difficulties develop, CNAs must position the resident upright at 90 degrees during meals, follow prescribed diet orders such as thickened liquids, encourage small bites and sips, and monitor closely for signs of aspiration including coughing, choking, a wet or gurgly voice, drooling, or food pocketing. Any of these signs should be reported immediately to the nurse.
Skin integrity is another major priority, especially as mobility decreases. Immobility increases the risk for pressure injuries, so residents should be repositioned at least every two hours if dependent, and skin should be kept clean and dry. CNAs must observe bony prominences and report redness or breakdown promptly. Respiratory status also requires close attention. Shortness of breath, increased fatigue, difficulty clearing secretions, or changes in breathing patterns should be reported right away.
Emotional Support and Dignity
Providing emotional support is equally important. Because most individuals with ALS remain cognitively intact, they are often fully aware of their declining physical abilities. This awareness can lead to anxiety, frustration, depression, or grief. CNAs should maintain dignity, speak directly to the resident, allow extra time for communication, and never assume confusion simply because speech is impaired. Supporting independence when possible and treating the resident with patience and respect are essential components of high-quality care.