ALS (Amyotrophic Lateral Sclerosis)

• ALS progression from: 
  • Independent ambulation to W/C or bedbound status
  • Normal speech to barely or not intelligible
  • Normal to pureed diet
  • Independent in most or all ADLs to needs major assist in all ADLs
• Change in ventilatory capacity
• Daytime somnolence/excessive daytime sleepiness
• Nutrition impairment
• Life-threatening complications
  • Fever recurrent after antibiotics
  • Recurrent aspiration pneumonia
  • Sepsis
  • Pyelonephritis
• Patient declines artificial ventilation
• Symptoms of sleep disordered breathing
• Unexplained confusion, headaches, anxiety, or nausea