In general, our body’s joints have movement within a specific range that varies a bit, person to person. You can move your shoulders, arms, and hands in various directions. Legs and feet, too. Even your back has a range of motion.

The range through which a joint can be moved, usually its range of flexion and extension, as determined by the type of joint, its articular surfaces, and that allowed by regional muscles, tendons, ligaments, joints and physiologic control of movement across the joint.

As we age, our joints and connected body parts lose some of that range of motion. ALS can be considered rapid aging as it reduces and limits range of motion; sometimes quickly, sometimes insidiously slow, but faster than normal aging.

Limited range of motion refers to a joint that has a reduction in its ability to move. Motion may be limited because of a problem within the joint, swelling of tissue around the joint, stiffness of the muscles, or pain

Respiratory onset ALS differs from more typical versions of the disease in that breathing muscles and back muscles are affected first, then— depending on how long a persons lives— limbs (legs, feet, arms, and hands), swallowing, and speech may be affected.

If breathing muscles are affected first, then what keeps me alive?

The ventilator. For the most part, the ventilator is a machine breathes for me and that extends life span beyond what is normal for most people who are afflicted with respiratory onset ALS.

What does that mean?

Other ALS symptoms— spastic muscles and limited range of motion— begin to appear. For example, my arms no longer can be held over my head. I cannot scratch my back or lift anything that weighs more than five pounds. Typing with spastic fingers is difficult. Even holding a fork or spoon has become an effort.

Can I put on the ventilator mask?

That has become a challenge each day. My physical therapist has given me a laundry list of specific exercises to keep joints and muscles working properly; to allow for enough range of motion to perform certain tasks; standing, putting on the ventilator mask, even typing (four of 10 fingers have decided to chart their own movement course).

Range of motion is in decline all over my body.

This is not fun.