Module 2: Nutrition Assessment Considerations

As the ALS disease progresses, there will be changes in the nurition-related issues and as a result patients will require regular follow-ups and assessments.

Dysphagia #

Swallowing difficulties during meal times including choking and coughing episodes significantly impact oral intake. It is important to speak with SLP to determine what diet texture and fluid consistency is the safest to ensure intake is optimized with safe swallowing strategies that minimize the risk of aspiration.

For more information, see Dysphagia and Swallowing Assessment

UE/LE Weakness #

Results in inability to prepare meals and consume meals independently resulting on heavily relying on caregiver/community support.

Some support may be provided by using adaptive equipment for decreased hand functionality.

Weight Loss #

Very common related to many factors including prolonged meal times, poor appetite and UE weakness.

Unintentional weight loss is very common and must be addressed immediatley to preserve muscle mass.

Go to this page to optimize strategies for oral intake.

GI Concerns/Issues #

Most reported: constipation (may be due to limited mobility or activity, poor fluid intake, poor fibre intake) or diarrhea, reflux and bloating/feeling gassy. CHanges to oral intake and/or enteral feeds will help resolve or manage these GI concerns/issues.

Respiratory Concerns/Issues #

Respiratory muscle weakness can impact mealtimes significantly resulting in prolonged meal times and reduced intake. If patient has Bipap or cough assist, it is important to encourage patient to use regularly and/or as prescribed by respirology team.

Dehydration #

Related to UE weakness and dysphagia which results inability to independently drink and meet adequate daily fluid intake needs. It is important to speak with SLP if it related to dysphagia and OT if it is related to UE weakness to provide options for adaptive utensils.

Adaptive eating and drinking utensils may provide some support.

Saliva #

Resulting in potential need for medications to reduce saliva such as Atropine/Elavil.

For more information, see Saliva Management.

Sources and Further Reading #

  • de la Cuesta, D. G., Sánchez, M. C. E., Fregenal, B. H., & Marsal, J. O. C. (2021). Needs of caregivers of amyotrophic lateral disease: a pilot study on multidisciplinary intervention. Revista Científica de la Sociedad de Enfermería Neurológica (English ed.)
  • Clinical Nutrition Handbook, Sunnybrook Health Sciences Centre: pg. 87-99 + references following summary + recommendations provided.
  • ALS Society of Canada: Swallowing, Nutrition and Oral Health, pg. 52-55.

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