Stages of ALS

Early Stages

The person with ALS may begin to experience fatigue, slurred speech, poor balance, weakened grip, stumbling while walking, or other initial symptoms. This stage may occur before a diagnosis is made.

Middle Stages

If muscles become unused, this may cause contractures, in which the joints become rigid, painful and sometimes deformed. Difficulty standing may occur. Weakness in swallowing muscles may cause choking, and greater difficulty eating and managing saliva. Weakness in breathing muscles can cause respiratory concerns, especially when lying down.

Late Stages

Most voluntary muscles become paralyzed. Respiratory muscles are severely compromised. Patient mobility is extremely restricted, and assistance is required to care for basic needs. Poor breathing may cause fatigue, affected cognition, headaches and increased likelihood of pneumonia. Speech, drinking or eating by mouth, may not be possible.

End Stage

The overwhelming majority of deaths in ALS are the result of respiratory failure, a process that progresses slowly over months
Far less common causes of death in ALS include malnutrition as a result of swallowing problems, pulmonary embolism (a blockage in one of the arteries of the lungs), abnormalities in the heart’s electrical pacing system called cardiac arrhythmias, and pneumonia as the result of aspiration (when food or fluid gets into the lungs).
Hospice care (in a facility or in the home) focuses on providing comfort and quality of life by supporting the physical, emotional and spiritual needs of the individual with ALS and his or her family members.