Could someone read this paper and tells me if this is good or do I need to change some stuff:

Introduction:
ALS is distinguish by insistent collapse of both upper motor neurons (UMN) and lower motor neurons (LMN) leading to progressive muscular paralysis and death usually within five years. Recent studies report yearly occurrence rates ranging from 1.5 to 2.5 cases 100,000 populations. The disease mainly affects people from aged 50–60 years with only 5% of patients having onset before the age of 30 years. It is usually not present at birth with heredity concerned in a sectional of cases. A 2008 study printed in Neurology showed that limb weakness is the most common indication at disease onset followed by dysarthria, dysphagia, cramps, fasciculation and shortness of breath. These LMN signs are often accompany with the health signs of UMN disease: overactive tendon reflexes, clonus and Babinski reply. After the disease begins, it follows a typical progressive course and it eventually affects almost all voluntary muscles. The cause of death is usually respiratory compromise related to diaphragm and intercostal weakness. Chiropractors often assess and treat patients for limb criticism. While many of these complaints, for example carpal tunnel syndrome and spinal radiculopathy often respond well to treatment some are more serious neuromuscular conditions that call for appropriate referral. ALS is one such disease that can simulator some of the limb conditions which are seen in chiropractic practice and may need to be considered as a differential diagnosis.
The purpose of this case report is to describe the presentation of a patient with upper limb weakness that she believed was secondary to her occupational demands as administrative assistant. Her condition had been previously diagnosed by her medical doctor as carpal tunnel syndrome. She was diagnosed with ALS by a neurologist one month after her performance to a chiropractic clinic and died 15 months later.

What is Amyotrophic Lateral Sclerosis (ALS): is a disease that breaks down tissues in the nervous system (a neurodegenerative disease) of unknown cause that affects the nerves responsible for movement. It is also known as motor neuron disease and Lou Gehrig's disease, after the baseball player whose career ended.
Diagnosing ALS: Amyotrophic Lateral Sclerosis is a very difficult disease to diagnose:
Diagnosis:
The diagnosis of ALS begins with a complete medical history and physical exam, plus a neurological examination to determine the distribution and extent of weakness. An electrical test of muscle function, called an electromyogram, or EMG, is an important part of the diagnostic process. Various other tests, including blood and urine tests, x rays, and CT scans, may be done to rule out other possible causes of the symptoms, such as tumors of the skull base or high cervical spinal cord, thyroid disease, spinal arthritis, lead poisoning, or severe vitamin deficiency. ALS is rarely misdiagnosed following a careful review of all these factors.
• Electro diagnostic tests including electromyography ( EMG) and nerve conduction velocity ( NCV)
• Blood and urine studies including high resolution serum protein electrophoresis, thyroid and parathyroid hormone levels and 24-hour urine collection for heavy metal
• Spinal tape
• X-rays, including magnetic resonance imaging ( MRI)
• Myelogram of cervical operation
• Muscle and nerve biopsy
• Thorough neurological examination
Symptoms of ALS: At the onset of ALS the symptoms may be so small that they are normally overlooked. With regard to the appearance of symptoms and the progression of the illness, the course of the disease may include the following:
• Muscle weakness in one or more of the following: hands, arms, legs or the muscles of speech, swallowing or breathing.
• Twitching (fasciculation) and cramping of the muscles, especially those in the hands and feet.
• Impairment of the use of the arms and legs
• “ Thick speech” and struggle in projecting the voice
• In more advanced stages, shortness of breath, difficulty in breathing and swallowing.

The symptoms of ALS can be quite diverse in different people. One person may experience tripping over carpet edges, another person may have trouble lifting and a third person’s early symptom may be an unclear speech. The rate at which ALS progresses can be quite variable from one person to another. Although the mean survival time with ALS is three to five years, many people live five, ten or more years. In a small number of people, ALS is known to concern or stop its movement, though there is no logical understanding as to how and why this happens. ALS symptoms can begin in the muscles of speech, swallowing or in the hands, arms, legs or feet. Not all people with ALS experience the same symptoms or the same sequences or patterns of progression. But, progressive muscle weakness and paralysis are generally experienced.

Muscle weakness is a hallmark sign in ALS, happening in approximately 60% of patients. Early symptoms differ with each individual, but usually include tripping, dropping things, abnormal tiredness of the arms and legs, slurred speech, muscle cramps and twitching or uncontrollable periods of laughing or crying.

The hands and feet may be affected first, causing difficulty lifting, walking or using the hands for the activities of daily living such as dressing, washing and buttoning clothes.

As the weakening and paralysis continue to spread the muscles of the trunk of the body the disease, eventually affects speech, swallowing, chewing and breathing. When the breathing muscles become affected, finally, the patient will need permanent ventilator support in order to survive.

Since ALS attacks only motor neurons, the sense of sight, haring, touch, taste and smell are not affected. For many people, muscles of the eyes and bladder are usually not affected.

Complication of the disorder:
As ALS progresses, one or more of the following complications may arise:
• Breathing Problems
The muscles needed to breathe are eventually paralyzed by ALS, leading to this disease’s most common cause of death: respiratory failure. Some people opt to have a tracheostomy to use the full time help of a ventilator that inflates and deflates their lungs.
• Eating Problems
As the muscles that control swallowing are affected, people suffering from ALS often develop undernourishment and thirst. They also run the risk of aspirating food, liquids and secretions into their lungs, which can lead to pneumonia.

• Dementia
• People with ALS are at higher risk of developing dementia and dementia-related conditions, including:

• Front temporal dementia
• Alzheimer’s disease

Treatment:
There is no cure for ALS, and no treatment that can significantly alter its course. There are many things which can be done, however, to help maintain quality of life and to retain useful ability even in the face of progressive weakness.

As of early 1998, only one drug had been approved for treatment of ALS. Riluzole (Rilutek) appears to provide on average a three-month increase in life hope when taken regularly early in the disease, and shows a significant slowing of the loss of muscle strength. Riluzole acts by decreasing glutamate release from nerve terminals. Experimental trials of nerve growth factor have not established any benefit. No other drug or vitamin currently available has been shown to have any effect on the course of ALS.

A physical therapist works with an affected person and family to device exercise and stretching programs to maintain strength and range of motion, and to promote general health. Swimming may be a good choice for people with ALS, as it provides a low-impact workout to most muscle groups. One result of chronic laziness is contracture, or muscle shortening. Contractures limit a person's range of motion, and are often painful. Regular stretching can prevent contracture. Several drugs are available to reduce cramping, a common complaint in ALS.

An occupational therapist can help design solutions to movement and coordination problems, and provide advice on adaptive devices and home changes.

Speech and swallowing difficulties can be minimized or delayed through training provided by a speech-language pathologist. This specialist can also provide advice on communication aids, including computer-assisted devices and simpler word boards.

Nutritional advice can be provided by a nutritionist. A person with ALS often needs softer foods to prevent jaw exhaustion or choking. Later in the disease, nutrition may be provided by a gastrostomy tube inserted into the stomach.

Mechanical ventilation may be used when breathing becomes too difficult. Modern mechanical ventilators are small and portable, allowing a person with ALS to maintain the maximum level of function and mobility. Ventilation may be administered through a mouth or nose piece, or through a tracheostomy tube. This tube is inserted through a small hole made in the windpipe. In addition to providing direct access to the airway, the tube also decreases the risk aspiration. While many people with rapidly progressing ALS choose not to use ventilators for lengthy periods, they are increasingly being used to prolong life for a short time.

The progressive nature of ALS means that most persons will eventually require full-time nursing care. This care is often provided by a spouse or other family member. While the skills involved are not difficult to learn, the physical and emotional burden of care can be over-whelming. Caregivers need to recognize and provide for their own needs as well as those of people with ALS, to prevent depression, burnout, and bitterness.

Throughout the disease, a support group can provide important psychological aid to affected persons and their caregivers as they come to terms with the losses ALS inflicts. Support groups are sponsored by both the ALS Society and the Muscular Dystrophy Association.

Most or all of this paper has been copied word for word from a different source.

http://www.alsa.org/about-als/symptoms.html

Your own first sentence has two errors.

In order to determine whether the paper is good or if some changes need to be made, it would be helpful to read through the paper and analyze its content, structure, and clarity. Here's a step-by-step guide on how to evaluate the paper:

1. Read the introduction: Start by reading the introduction of the paper to understand the topic it discusses and the purpose of the case report. Pay attention to the clarity and organization of the information. Does the introduction effectively communicate the background information and context of ALS?

2. Evaluate the paper's structure: Assess how well the paper is structured. Is there a clear introduction, body, and conclusion? Do the sections flow logically from one to another? Are the headings and subheadings appropriately used to guide the reader?

3. Check the information provided: Determine if the paper provides relevant and accurate information about ALS. Review the definition of ALS, its symptoms, methods of diagnosis, complications, and treatment options. Verify if the information aligns with current medical knowledge and research in the field of ALS.

4. Assess the language and writing style: Evaluate the clarity and readability of the paper. Are the sentences and paragraphs well-constructed and easy to understand? Is the writing style appropriate for a scientific paper? Look for any grammatical errors or typos that might need correction.

5. Consider the depth of analysis: Assess whether the paper provides a comprehensive analysis of the case study. Does it discuss the patient's symptoms, diagnostic process, and treatment in detail? Does it use relevant scientific literature to support the claims and conclusions made? Look for any gaps or missing information that could be improved.

6. Evaluate the conclusion: Read the conclusion of the paper and determine if it effectively summarizes the key findings and recommendations. Does it address the initial purpose of the case report and provide insights or implications for further research or clinical practice?

7. Seek feedback from others: Once you have evaluated the paper yourself, it can be helpful to seek feedback from others, such as colleagues or experts in the field, to get different perspectives and insights. They may be able to identify any weaknesses or areas of improvement that you might have missed.

Remember, this is a general guide on how to evaluate the paper. The specific criteria and standards for "good" or "needing changes" will depend on the intended audience, the purpose of the paper, and any specific guidelines or requirements set by the publisher or institution.