, 2010). In addition, small frequent feeds, and a large amount of fluid is provided to maintain the nutritional needs of the patient and prevent dehydration. The r suctioning of secretions proves necessary in preventing aspiration of secretions. The loss of voluntary muscle's activity increases the risks of accumulation of secretions hence, the need for regular suctioning. Bulbar involvement often results in communication complications such as dysarthria and muscle paralysis of the muscles of the face, throat, and tongue. As such, it requires the provision of management strategies such as augmentative and alternative communication (AAC) techniques and other forms of speech therapy that improves the communication abilities of patients with ALS. Pseudobulbar effects that often accompany those brought by the frontotemporal lobe degeneration often require the administration of antidepressants. The antidepressants manage mood disorder that presents through disproportionate crying, and inappropriate response to the external stimuli. Maximizing patients' comfort and independence require the provision of services such as occupational therapy, physical therapy, and exercise. The exercises entail providing a wide range of movements that prevent loss of muscle functioning and ensuring maximizing the patient's comfort and independence (Ganzini et al. 1998).

Spasm and cramping of the muscles might result in pain. As such, this requires the administration of analgesics such as quinine sulfate to provide relief from the pain. Provision of various exercises like moderate intensity and endurance type helps in reducing the spasticity of the voluntary muscles hence, relieving from the pain. Surprisingly, depression and risks of suicide occur in patients with ALS. Depression occurs because of the poor quality of life that increases suicidal ideations hence, the risk of committing suicide. Thus, the nature of care provided should not only focus on antidepressant's medication but also the provision of professional counseling and early identification and management of correctable factors. Apart from this, the patient requires the provision of services that meet the spiritual needs of the patient. This entails providing opportunities that make them close to their God, improving the quality of life of patients with ALS. Above all, the health care providers should engage families in the provision of care to patients with ALS. This equips the family with the necessary skills and empowers them, hence, improving the positive outcomes of both the patient and the family (Crespi et al. 2014).

Efficacy studies to review the effectiveness of Physical Therapy, Occupational Exercises, and Exercise in Managing Amytrophic Lateral Sclerosis

It is shown that physical therapy, occupational exercises, and exercises contribute positively to the health and health outcomes of patients with ALS. Physical and occupational therapist assists the patients and families by providing education, rehabilitation programs, psychological support, and recommendations for the most appropriate community resources and equipment required to improve the patient's outcomes. According to NOLAN et al., (2008) physical therapy and occupational exercises improve the quality of life of the ALS patient by optimizing their health outcomes and increasing their independence across all stages of ALS. The exercises preserve the mobility and flexibility of joints on which a range of activities are performed. As such, the exercises reduce muscle stiffness thereby, preventing or slowing down the progression of muscle function loss.

A study conducted by Mitchell and Borasio (2007) sought to determine the effectiveness of the resistance exercise on the health outcomes of patients with ALS. It showed that exercising had significant influence on the outcomes of the ALS patients. Isometric strength training on ALS patients has been reported to improve their health and health outcomes. Similarly, empirical evidence shows that aerobic exercises prove effective in improving the health outcomes of the ALS patients by slowing down the rate of voluntary muscle's degeneration hence, optimize health outcomes. A study conducted by Neary, Snowden and Mann (2000) showed a significant correlation between the provisions of muscle strengthening exercises with lifestyle modification. The study showed that, combining the lifestyle modification with the muscle strengthening exercises led to improvement of the psychological well-being and reduced muscle degeneration hence, its effectiveness.

A review conducted by Ozanne & Persson (2013) sought to evaluate how the effectiveness of occupational exercises and physical therapy contributed to the increased comfort and independence. Exercises like quad-cane and straight-cane are effective in managing ALS stage II. They prevent excessive degeneration of the involuntary muscles and increase the active involvement of the patient in activities that increases independence. As the disease progresses, introducing the use of adaptive equipment becomes beneficial as it replaces...

Providing exercises such as stretching and range motion exercises prevent or reduce the incidences of contractures and muscle spasticity hence, reducing pain and maintaining optimum functioning of the muscles (Mitchell & Borasio, 2007).
However, the use of more vigorous exercises does not produce a significant impact on the outcomes in patients with ALS. This implies that, moderate resistance exercises prove more effective in managing ALS than the vigorous resistance exercises. Regular provision of moderate resistance exercises significantly improves the health of patients with ALS. It improves the static force of the voluntary muscles thereby, contributing to the slowing down of muscle degeneration. The Ashworth Spasticity Scale and ALS Functional Rating Scale that show the improved muscle functioning with the provision of regular muscle exercises attests these results. Similarly, physical and occupational exercises also improve the health and health outcomes of patients with respiratory insufficiency. It increases the secretion ability of the voluntary muscles and the tidal capacity of the lungs hence, enhanced respiratory functioning. Therefore, physical and occupational therapy proves most effective in the treatment of ALS as it improves the health outcomes of patients by increasing their independence and maximizing their comfort (Management n.d).

Conclusion

In summary, ALS affects the health and health outcomes of an individual negatively. It affects their abilities to perform the activities of the daily living. Although the condition lacks an effective method for treating the condition, the available alternatives help in improving the quality of life, optimizing their health outcomes, and increasing their independence. Therefore, it is highly recommendable to include family and significant others close to the patient to equip them with the required skills and empower them.

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