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What is ALS?
Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease (肌萎縮性側索硬化症, 又稱漸凍人症), is a progressive neurodegenerative disorder that affects nerve cells in the brain and spinal cord. It involves the brain's loss of connection with the muscles, slowly leading to inability to walk, talk, eat and eventually breathe.
What causes ALS?
The ALS cause is a complex interplay of genetic and environmental factors. Some of the known causes and risk factors include:
Genetic Factors (Familial): ALS is inherited in about 5-10% of cases.
Sporadic ALS: There are many ALS cases (90-95%) without a clear family history. Sporadic cases are thought to result from a combination of genetic predisposition and environmental factors, although the exact mechanisms are not fully understood.
Common ALS symptoms
Muscle Weakness
The earliest and most common symptom is muscle weakness, which typically starts in the limbs. It can manifest as difficulty with tasks like grasping objects, walking, speaking, or swallowing.
Muscle Atrophy
As the disease progresses, muscle atrophy (wasting) occurs due to the loss of motor neurons. This leads to a visible decrease in muscle size and strength.
Spasticity
Some individuals with ALS may experience muscle stiffness and spasms, known as spasticity. This can cause muscle cramps, discomfort, and difficulty with movement.
Difficulty Speaking and Swallowing
Weakness in the muscles responsible for speech and swallowing can result in slurred speech, difficulty forming words, and difficulty swallowing.
Breathing Difficulties
As ALS affects the respiratory muscles, individuals may experience breathing difficulties, shortness of breath, and eventually respiratory failure. This is the most common cause of death in ALS.
ALS Stages
ALS (Amyotrophic Lateral Sclerosis) is typically divided into several stages based on the progression of symptoms and functional decline. The progression and duration of each stage can vary from person to person. The following general stages are commonly observed:
Early Stage
In the early stage of ALS, individuals may experience mild symptoms such as:
-Muscle weakness
-twitching (fasciculations)
-cramping.
The weakness usually begins in the hands, arms, legs, or feet and may affect one side of the body initially. Tasks that require fine motor skills, such as buttoning a shirt or gripping objects, may become more challenging. Despite these symptoms, individuals can still perform most activities of daily living (ADLs) independently.
Intermediate Stage
During the intermediate stage, muscle weakness and atrophy progress, affecting more areas of the body. The weakness spreads to both sides of the body, involving the arms, legs, trunk, and respiratory muscles.
Mobility and coordination become increasingly difficult, and individuals may require assistive devices such as canes, walkers, or wheelchairs to aid in mobility. Speech and swallowing difficulties may also arise, requiring adaptive techniques or assistive devices for communication and eating.
Advanced Stage
In the advanced stage of ALS, individuals experience significant muscle weakness and widespread paralysis. They may lose the ability to walk, stand, or perform self-care tasks independently. Assistance with ADLs becomes essential, and caregivers or doctors may be needed to provide support.
Communication may become severely impaired, leading to alternative communication methods such as eye-tracking or speech-generating devices. Respiratory function continues to decline, and individuals may require non-invasive ventilation or a tracheostomy to assist with breathing.
End Stage
The end stage of ALS is characterised by near-total paralysis and severe respiratory compromise. Individuals are typically bedridden and highly dependent on caregivers for all aspects of care. Communication is limited, and respiratory support becomes critical to sustain breathing. Complications such as infections, respiratory failure, or nutritional difficulties may arise, leading to end-of-life care considerations.
ALS is a progressive and incurable disease, and supportive care from a multidisciplinary team is crucial to address the physical, emotional, and psychosocial needs of individuals with ALS throughout each stage of the disease.
What interventions can physiotherapists do for ALS?
Physiotherapy can aid in the management of ALS by addressing physical challenges and maximising functional abilities. Here are some common physiotherapy interventions for ALS:
Range of Motion Exercises
Passive and active range of motion exercises help maintain joint flexibility and prevent muscle stiffness and contractures.
Strengthening Exercises
Specific strengthening exercises can help maintain muscle strength and reduce muscle wasting. These exercises are tailored to the individual's abilities and focus on the muscles most affected by ALS.
Breathing Exercises
Respiratory muscle weakness is a significant concern in ALS. Physiotherapists can teach breathing exercises to improve lung capacity, maintain effective breathing patterns, and manage respiratory symptoms.
Assistive Devices
Physiotherapists can assess the need for assistive devices such as mobility aids, orthoses, or adaptive equipment to aid with activities of daily living and enhance independence.
Postural Management
Maintaining proper posture to prevent discomfort and complications. Physiotherapists can guide positioning and recommend appropriate support or equipment to promote optimal posture.
Fall Prevention
As weakness progresses, the risk of falls increases. Physiotherapists can assess balance and gait and implement strategies to minimise fall risks such as balance exercises and recommending appropriate assistive devices.
Pain Management
Physiotherapists can employ techniques like manual therapy, heat or cold therapy, and transcutaneous electrical nerve stimulation (TENS) to help manage pain and discomfort associated with ALS.
Do note that physiotherapy interventions are personalised based on the individual's specific needs and stage of the disease. The treatment plan may evolve and adapt as the condition progresses. For accurate and tailored information about physiotherapy for ALS, it's best to consult a doctor or refer to reliable sources such as the OT&P website.
ALS is a highly variable disease, and the progression and symptoms can differ from person to person. If you suspect you or someone you know may have ALS, it's crucial to consult a doctor for an accurate diagnosis and appropriate management.
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- RPT(H.K.)
- RPT(U.K.)
- BSc Hon in Physiotherapy, University of Birmingham
English, Cantonese, Fluent Mandarin
}', 4='{type=string, value=Victor Chan is a hands-on physiotherapist who helps patients to reach their ultimate health goals. His profession goes beyond reducing their pain, improving the quality of patients' life.
His core objectives are to identify the mechanisms of injuries, understand patients' needs, educate patients through clinical reasoning, and provide tailor-made injury prevention plans. In addition, he has established a holistic patient-centered care approach to build a trusting relationship with patients.
Victor offers a wide range of treatments under various medical conditions. His western treatment includes joint mobilisation, soft tissue release, rehabilitation exercise prescription, and electrotherapy. In the meantime, he also provides Chinese medicine, including Chinese cupping and muscle scraping.
Victor completed his physiotherapy degree at the University of Birmingham in 2017. After graduation, he returned to Hong Kong and joined Tai Po Football Club as a sports physiotherapist. He then entered private practice and worked as a managing physiotherapist for Cathay Pacific and Bank of China.
}', 6='{type=image, value=Image{width=491,height=615,url='https://www.otandp.com/hubfs/victor-chan-1.jpg',altText='',fileId=null}}', 7='{type=list, value=[{id=61148854915, name='Physiotherapy'}, {id=153457093927, name='TPI Certified Instructor'}]}', 9='{type=list, value=[{id=59518997850, name='BodyWorX Clinic'}]}', 10='{type=number, value=66}', 11='{type=option, value={id=2, name='Health Practitioner', order=1, label='Health Practitioner'}}', 12='{type=string, value=Victor Chan is a physiotherapist with qualifications from the UK and Hong Kong. Learn more here.}', 13='{type=string, value=- Pain management
- Post operative rehabilitation
- Sports rehabilitation
- Ergonomic assessment
- Manual therapy
- BSc Physiotherapy (The Netherlands)
- Diploma in Acupuncture (China)
- Certified Neuro-Rehabilitation Specialist (HK)
- Certificate in Sport Rehabilitation (The Netherlands)
English, Cantonese, Mandarin, Dutch
}', 4='{type=string, value=Selina Cheung has more than 17 years of experience as a physiotherapist in the Netherlands and Hong Kong. Graduated from the Hogeschool van Amsterdam, University of Applied Sciences in 1994, Selina specializes in musculoskeletal problems, sports injuries, back and neck problems as well as women's health.
Before she moved to Hong Kong, Selina worked in both private practice and hospital settings in the Netherlands.
In Hong Kong, Selina spent over a decade in a rehabilitation centre, where she worked with sport and spinal cord injuries. She also designed return-to-work programmes for chronic back pain patients. A well-trained acupuncture practitioner, she is fascinated by the synergy effect of combining the traditional treatment and other physiotherapy modalities in treating patients.
Selina is also very interested in women's health. In particular, she has gained postgraduate qualifications in pelvic floor rehabilitation, antenatal and postnatal care as well as menstrual problems. Neuro-rehabilitation is another area that Selina is passionate about. She has extensive postgraduate training in neurology and regularly gives lectures to students and physiotherapist graduates.
When not working, she spends a great deal of time on community work. In 2008, she went to Sichuan to help the earthquake victims by giving them physiotherapy treatments.
Regularly, she gives talks to different charities organizations. A sports enthusiast who enjoys skiing, volleyball and jazz ballet, she is also a volunteer physiotherapist in a few international figure skating and ice hockey institutes.
}', 6='{type=image, value=Image{width=null,height=null,url='https://cdn2.hubspot.net/hubfs/4943668/SelinaCheung.jpg',altText='',fileId=null}}', 7='{type=list, value=[{id=61148854915, name='Physiotherapy'}]}', 9='{type=list, value=[{id=59518997850, name='BodyWorX Clinic'}]}', 10='{type=number, value=67}', 11='{type=option, value={id=2, name='Health Practitioner', order=1, label='Health Practitioner'}}', 12='{type=string, value=Selina Cheung is a physiotherapist with qualifications from the Netherlands, China and Hong Kong. Learn more here.}', 13='{type=string, value=- Musculoskeletal Problems
- Sport Injuries
- Back and Neck Problems
- Acupuncture
- Women's Health
- Neurology
- Masters in Clinical Physiotherapy - Pelvic Health and Continence (AUS)
- Bachelor of Science - Physiotherapy (AUS)
- HKPA Registered Physiotherapist
- AHPRA Registered Physiotherapist
- Certified Pre- Post Postnatal Coach (GGS)
English, French
}', 4='{type=string, value=Camille completed her studies in Australia where she also worked in both private clinic and hospital settings.
Camille has a particular interest in pelvic health for athletes and post-partum return to high-impact sport. She has an integrative and transparent approach and an experienced understanding of how to help achieve your individual goals with physiotherapy.
- Female, male and children pelvic health and continence
- Urinary & bowel incontinence and dysfunction
- Overactive bladder
- Pelvic Organ Prolapse
- Pre- and post-natal care
- Post-natal return to high impact sport
- Rectus diastasis
- Pelvic floor dysfunction and pain
- Pelvic pain (endometriosis, Genito Pelvic Pain Penetration Disorder including dyspareunia, vulvodynia/vestibulodynia)
- Sexual pain and dysfunction
- Pre- and post-op care gynaecological or urological surgery (hysterectomy and prostatectomies), and pelvic radiation treatment
- Lactating breast: cracked nipples, blocked ducts and mastitis
- Breast cancer related cording, joint stiffness, reduced strength and endurance.
- Musculoskeletal pain including neck, back and pelvic pain
- Sporting injuries
- Headaches
- Registered Physiotherapist
- IBCLC Lactation Consultant
- Master in Manual Therapy (Australia)
- BSc (Hons) Physiotherapy (UK)
- Dip. Clinical Acupuncture (HKU)
After graduated at King’s College London, Wendy returned to Hong Kong in 2005 and began her career in private practice, but also spent four years gaining invaluable experience working in Hong Kong’s public hospitals. Wendy was the Team Physiotherapist for rugby at the Hong Kong Football Club; the Hong Kong Orienteering Team at the Asian Orienteering Championships in 2014; and part of the physiotherapy team at the ITU Triathlon Asian Cup in 2013.
Over the years of her practice, Wendy has developed a special interest in pelvic health, which motivated her to complete her specialty training in Australia and became a qualified Women’s Health and Men’s Health Physiotherapist. In addition to her orthopedic background, Wendy is able to skillfully treat a full spectrum of pelvic issues in both men and women using both specialist knowledge and skills in pelvic health and a holistic biomechanical approach, which involves assessing the whole body and optimising body alignment to identify the root cause of the problem in order to enable full neuromuscular function. Wendy also uses ‘core’ training (Pilates) principals to formulate the most effective rehabilitation and strengthening program for conditions ranging from post-partum women returning to exercise, to the elite level athlete. As a mother, Wendy understands the demands placed on a woman's body from pregnancy and childbirth. She also understands the changes that a woman's body undergoes from early adulthood to more senior years. She is dedicated to help women both physically and mentally in all stages of life.
Wendy is also committed to support breastfeeding mothers by becoming an International Board Certified Lactation Consultant (IBCLC). Having gone through her own breastfeeding journey, Wendy understands the physical and mental demands that could be placed on a breastfeeding mother. This specialty enables her to assist both the breastfeeding mother and her baby to overcome various issues throughout their breastfeeding journey. Conditions include latch/sucking problem, nipple pain/damage, tongue tie, breast refusal, low/ oversupply, blocked ducts and mastitis etc could lead to early weaning from breastfeeding. Early detection and management of these conditions can successfully optimize the duration of breastfeeding which results in better health outcome to mother and baby both physically and mentally.
Wendy is available to treat any musculoskeletal conditions, sports injuries, women’s & men’s health conditions and pregnancy & breastfeeding issues.}', 6='{type=image, value=Image{width=491,height=615,url='https://www.otandp.com/hubfs/wendy-shum.jpg',altText='',fileId=null}}', 7='{type=list, value=[{id=61148854915, name='Physiotherapy'}]}', 9='{type=list, value=[{id=59518997850, name='BodyWorX Clinic'}]}', 10='{type=number, value=87}', 11='{type=option, value={id=2, name='Health Practitioner', order=1, label='Health Practitioner'}}', 12='{type=string, value=Wendy Shum is a physiotherapist with qualification from Hong Kong and UK. Learn more here. }', 13='{type=string, value=
- Women’s Health including Urinary or Faecal Incontinence, Pelvic Organ Prolapse, Pelvic Floor Muscle Retraining, Bladder Dysfunction, Dyspareunia (pain during intercourse), Vaginismus and Coccyx Pain
- Prenatal and Postnatal Issues including Pregnancy Lumbopelvic Pain and Rectus Abdominis Diastasis
- Breastfeeding Issues - Blocked Ducts or Mastitis
- Men’s Health
- Pelvic Girdle Pain
- Neck and Back Pain
- Musculoskeletal Conditions
- Sports Injuries
- Registered Physiotherapist
- B.Phty of Otago University (New Zealand)
- Hong Kong Men’s National Rugby Fifteen and Sevens teams. (10 plus years, over 50 matches and 7’s tournaments).
- Asian and European Golf Tours. (15 plus events). Including Seve Ballesteros Royal Trophy - Europe vs Asia.
- HK Team Physiotherapist Busan Asian Games. (Covering Hockey and Games Village Clinic)
- HK Gaelic Football International Tours.
- International Tennis exhibition tournaments. (Including Pete Sampras vs Andre Agassi)
- Sports Physiotherapy
- Back and Neck Pain
- Post Operative Rehabilitation
- Dry Needling
- Personalised Exercise Prescription - all ages!
- Running Assessments
- BSc Physiotherapy (UK)
- Registered physiotherapist (UK)
- Registered physiotherapist (HK)
- Diploma in Modern acupuncture
- Qualified clinical Pilates instructor
With experience working in both the NHS (UK) and various private clinics in Hong Kong, Celia has had the opportunity to treat patients from all walks of life. She provides various treatment modalities, including acupuncture, exercise therapy, clinical pilates, taping, and manual techniques. Celia also aims to get her patients to engage actively in their recovery through education and setting clear goals.
Celia completed her degree in Physiotherapy from Coventry University in 2019. She adheres to the highest professional standards as a member of the Chartered Society of Physiotherapy (CSP) and registered with the Health and Care Professions Council (HCPC). She is dedicated to providing exceptional patient care. Celia enjoys staying active and supporting local sports teams in her spare time.}', 6='{type=image, value=Image{width=982,height=1230,url='https://www.otandp.com/hubfs/Celia%20Leung_Headshot.png',altText='',fileId=null}}', 7='{type=list, value=[{id=61148854915, name='Physiotherapy'}]}', 9='{type=list, value=[{id=59518997850, name='BodyWorX Clinic'}]}', 10='{type=number, value=105}', 11='{type=option, value={id=2, name='Health Practitioner', order=1, label='Health Practitioner'}}', 12='{type=string, value=Celia Leung is a physiotherapist with qualification from Hong Kong and UK. Learn more here. }', 13='{type=string, value=
- Neck and back pain
- Acupuncture
- Musculoskeletal condition
- Sports injuries
- Chronic pain management
- Manual therapy
