Functional ambulation decline and factors associated in amyotrophic lateral sclerosis

Abstract

Introduction: Amyotrophic lateral sclerosis (ALS) is a disabling neurodegenerative disease, which compromises locomotion and functional independence. As the goal of physical therapy is to maintain the individual's locomotion capacity and independence as long as possible, it is necessary to gain a better understanding of the possible factors associated with the loss of this capacity. Objective: To evaluate functional ambulation in patients with ALS and possible factors associated with its decline. Methods: A cross-sectional study was conducted with sporadic ALS patients. Demographic and clinical/functional aspects were evaluated. ALS Functional Rating Scale-Revised (ALSFRS-R), Functional Ambulation Category, Medical Research Council scale and Fatigue Severity Scale were used. Descriptive and comparative analyses were conducted of the groups capable and incapable of functional ambulation. Binary logistic regression (stepwise forward method) was performed to determine potential factors associated with the loss of functional ambulation. Results: Among the 55 patients (mean age: 56.9 ± 11.2 years), 74.5% were able to walk functionally. Differences were found between groups regarding time of diagnosis, number of falls, pain, use of noninvasive ventilation, gastrostomy, ability to turn in bed, mobility aids, home adaptations, functional performance, muscle strength and fatigue. The possible predictors of walking disability were overall muscle strength (OR = 0.837; p = 0.003) and fatigue (OR =1.653; p = 0.034). Conclusion: Muscle strength and fatigue are associated with the decline in ambulation capacity in patients with ALS. In view of the complexity of elements involved in walking, further studies are needed to investigate the influence of these aspects in this population.