Stages of Amyotrophic Lateral Sclerosis ( ALS)

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IER Book page 129 v2009

Stage I

early disease, mild focal weakness, asymmetrical distribution
symptoms of hand cramping and fasciculation (LMN signs)

Stage II

moderate weakness in groups of muscles
some wasting (atrophy) of muscles
modified independence with assistive devices

Stage III

severe weakness of specific muscles, increasing fatigue
mild to moderate functional limitations, ambulatory

Stage IV

severe weakness and wasting (atrophy) of LEs
mild weakness of UEs, moderate assistance
assistive devices required, wheelchair user

Stage V

progressive weakness with deterioration of mobility and endurance, increased fatigue
moderate to severe weakness of whole limbs and trunk
spasticity; hyperreflexia (UMN signs); loss of head control
maximal assist

Stage VI

bedridden, dependent ADL, FMS
progressive respiratory distress

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