2. The Development – The Escalation of ALS Symptoms
As ALS evolves into its second stage, the subtlety that characterised the initial stage begins to fade. The muscle weakness that started as a minor concern escalates and broadens its influence on the body, spreading to other muscles that were previously unaffected. This includes the critical muscles responsible for key bodily functions such as speaking, swallowing, and even breathing.
In the medical perspective, the spreading muscle weakness signals the worsening of motor neuron damage. As motor neurons continue to deteriorate, they lose their ability to send signals to muscles, resulting in increasing muscle weakness.
It’s at this stage that muscle atrophy – the wasting away of muscles due to lack of use – becomes significantly noticeable. The physical manifestation of ALS in this stage can range from visible muscle thinning to noticeable changes in the way patients move and handle routine tasks.
The symptom progression and physical manifestations begin to translate into noticeable functional impairments in this stage. Muscle weakness and atrophy start taking a toll on the patients’ daily activities.
Patients might find it challenging to carry out tasks that once were effortless, such as walking, gripping objects, or articulating words. Some individuals might also exhibit changes in their speech, a condition known as dysarthria, which occurs due to the impact of ALS on the muscles that control speech.
At this stage, it’s crucial to understand that ALS is a heterogeneous disease, meaning it affects everyone differently. Therefore, the kind of functional impairments experienced by one patient might differ substantially from another. For example, while some patients might primarily have difficulties with mobility, others might struggle more with tasks involving fine motor skills, such as buttoning a shirt or writing. (2)
