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44 · 57 · 62. In the last stages of als, the majority of voluntary muscles suffer from paralysis, and the muscles that bring air into and out of the lungs no longer function properly. Al nassr » squad 2022/2023 ; Patients in this phase of the disease require significant medical assi. Early signs of amyotrophic lateral sclerosis, or als, include tripping and difficulty walking, clumsiness and weakness in the hands, slurring of speech and trouble swallowing, according to mayo clinic.