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Ms. NR - Coggle Diagram

- - - - Middle
        
        more widespread symptoms
      - Late
        
        limited speech, respiratory issues, mobility extremely limited
      - Early
        
        mild or limited to one area
    - - Bulbar
        
        Onset is more related to speech
      - Spinal
        
        Ms NR likely had this type
        
        asymmetric limb weakness is the most typical presentation (80%) while 20% of patients have bulbar onset
        
        Onset is weakness/atrophy
    - - 10-20% of ALS patients can live for 10 years or more after initial diagnosis
      - most individuals live an average of 3-5 years after the onset of symptoms
      - factors associated with longer survival are: younger age at symptom onset, higher LAS functional rating scale, increased FVC at presentation and limb rather than bulbar symptom onset
    - - 3.8 months: first consultation
      - 8 months: diagnosis
      - 16.2 months: employment change
      - 17.5 months: walking aid
      - 18.5 months: caregiver needed
      - 22.8 months: wheelchair bound
      - 24.6 months: communication aid
      - 27.3 months: respiratory aid
      - 28.6 months: gastrostomy
      - 29.7 months: eye gaze technology
      - 30.3 months: care facility
      - 36 months: death
  - - - Employers with >15 employees
      - Guarantees equal opportunity (recruitment, hiring, promotion, training, pay, socially)
      - Federal protection
      - The Rehabilitation Act of 1973 protects disabled employees from discrimination and works in conjunction with the ADA
    - - Age >18 years old
      - Unable to work for at least 12 months or until death
      - Have not been denied benefits in past 60 days
  - - - NPPV initiated when FVC < 50% predicted
      - Mechanical ventilation will eventually be necessary
        
        Patient can opt to not be ventilated
  - - - Guardianship defaults to the remaining living parent
    - - Ms. NR should consider if she wants to name her Aunt as the standby guardian for Gary considering she has already stepped in to help take care of him and develop a relationship
    - - Full custody falls to the remaining living parent
    - - Guardianship is decided in court based on the child's best interest
        
        Guardianship can be defined in a living will
        
        Family members or family friends can petition the court for guardianship
        
        Ideal guardian has already established a connection with the child
        
        No suitable option for guardianship
        
        Foster system
  - - - "Compassionate allowance," automatically qualifies for Medicare on approval