肌萎縮性脊髓側索硬化症
Amyotrophic lateral sclerosis

context: zh_tw: 咀嚼和吞嚥困難都會增加進食的難度，以及窒息和將食物吸入肺部的風險。在患病的晚期，吸入性肺炎會加重，而保持正常的體重也會越加困難，並有可能需要透過插管進食。隨著膈肌和肋間肌的無力，呼吸也會開始衰弱。肺功能指標，比如肺活量和吸氣壓力都會下降。呼吸起病患者，這些症狀可能在四肢發病前出現。
en: Difficulties with chewing and swallowing make eating very difficult and increases the risk of choking or of aspirating food into the lungs. In later stages of the disorder, aspiration pneumonia can develop, and maintaining a healthy weight can become a significant problem that may require the insertion of a feeding tube. As the diaphragm and intercostal muscles of the rib cage that support breathing weaken, measures of lung function such as vital capacity and inspiratory pressure diminish. In respiratory-onset ALS, this may occur before significant limb weakness is apparent. Most people with ALS die of respiratory failure or pneumonia.Although respiratory support can ease problems with breathing and prolong survival, it does not affect the progression of ALS. Most people with ALS die between two and four years after the diagnosis. Around half of people with ALS die within 30 months of their symptoms beginning, and about 20% of people with ALS live between five and 10 years after symptoms begin. Guitarist Jason Becker has lived since 1989 with the disorder, while cosmologist Stephen Hawking lived for 55 more years following his diagnosis, but they are considered unusual cases.Most people with ALS die in their own home, with their breath stopping while they sleep.
qas: question: zh_tw: 進食困難的原因是什麼？
en: what makes eating difficult?
answers: zh_tw: text: 咀嚼和吞嚥困難
en: text: Difficulties with chewing and swallowing

context: zh_tw: 目前大約 90% 的病例沒有家族病史，即不能明確病因。尚不確定的潛在病因包括頭部外傷，兵役，頻繁用藥和參與身體接觸性運動。
en: Where no family history of the disease is present — around 90% of cases — no cause is known. Possible associations for which evidence is inconclusive include military service and smoking. Although studies on military history and ALS frequency are inconsistent, there is weak evidence for a positive correlation. Various proposed factors include exposure to environmental toxins (inferred from geographical deployment studies), as well as alcohol and tobacco use during military service.A 2016 review of 16 meta-analyses concluded that there was convincing evidence for an association with chronic occupational exposure to lead; suggestive evidence for farming, exposure to heavy metals other than lead, beta-carotene intake, and head injury; and weak evidence for omega-three fatty acid intake, exposure to extremely low frequency electromagnetic fields, pesticides, and serum uric acid.In a 2017 study by the United States Centers for Disease Control and Prevention analyzing U.S. deaths from 1985 to 2011, occupations correlated with ALS deaths were white collar, such as in management, financial, architectural, computing, legal, and education jobs. Other potential risk factors remain unconfirmed, including chemical exposure, electromagnetic field exposure, occupation, physical trauma, and electric shock. There is a tentative association with exposure to various pesticides, including the organochlorine insecticides aldrin, dieldrin, DDT, and toxaphene.
qas: question: zh_tw: 當沒有家族病史時，即怎定病因？
en: When there is no family history of disease then the cause if what?
answers: zh_tw: text: 不能明確病因
en: text: no cause is known

context: zh_tw: 物理治療在肌萎縮側索硬化症患者的病情改善上起到了很大作用。具體來說，物理及職業治療師可以設定康復目標，並透過延長力量衰退的時間，維持耐力，減緩疼痛，預防併發症的發生，促進功能自理能力等方面提升肌萎縮側索硬化症患者的身體素質。職能治療和特殊裝置等輔助技術也可以提高患者在肌萎縮側索硬化症程序中的自理和安全。溫和的低強度有氧運動，如日常生活自理活動、散步、游泳、騎腳踏車都可以鍛鍊未受影響的肌肉，改善心血管健康，並可幫助患者對抗疲勞和憂鬱。由職能治療師設計的功能性運動和關節伸展可以幫助患者預防痛苦的痙攣和肌肉的縮短（攣縮）。職能治療師可協助病患在肌肉無超過負荷的情況下得到鍛鍊。他們建議使用如坡道、吊帶、代步車、衛浴裝置（淋浴椅，廁所扶手等）和輪椅來幫助患者轉位移動。職能治療師可以提供或推薦裝置並且可調整使人們能安全地自理日常生活。
en: Physical therapy plays a large role in rehabilitation for individuals with ALS. Specifically, physical, occupational, and speech therapists can set goals and promote benefits for individuals with ALS by delaying loss of strength, maintaining endurance, limiting pain, improving speech and swallowing, preventing complications, and promoting functional independence.Occupational therapy and special equipment such as assistive technology can also enhance people's independence and safety throughout the course of ALS. Gentle, low-impact aerobic exercise such as performing activities of daily living, walking, swimming, and stationary bicycling can strengthen unaffected muscles, improve cardiovascular health, and help people fight fatigue and depression. Range of motion and stretching exercises can help prevent painful spasticity and shortening (contracture) of muscles. Physical and occupational therapists can recommend exercises that provide these benefits without overworking muscles, because muscle exhaustion can lead to worsening of symptoms associated with ALS, rather than providing help to people with ALS. They can suggest devices such as ramps, braces, walkers, bathroom equipment (shower chairs, toilet risers, etc.), and wheelchairs that help people remain mobile. Occupational therapists can provide or recommend equipment and adaptations to enable ALS people to retain as much safety and independence in activities of daily living as possible.People with ALS who have difficulty speaking may benefit from working with a speech-language pathologist. These health professionals can teach people adaptive strategies such as techniques to help them speak louder and more clearly. As ALS progresses, speech-language pathologists can recommend the use of augmentative and alternative communication such as voice amplifiers, speech-generating devices (or voice output communication devices) or low-tech communication techniques such as head mounted laser pointers, alphabet boards or yes/no signals.
qas: question: zh_tw: 提到了什麼低強度有氧運動？
en: What low-impact aerobic exercises are mentioned?
answers: zh_tw: text: 日常生活自理活動、散步、游泳、騎腳踏車
en: text: daily living, walking, swimming, and stationary bicycling