ALS can present with UMN and LMN lesion of either upper or lower limbs. This card is confusing to some because, if it is a UMN lesion no matter if upper or lower limb it will present with spastic paralysis and if there is a LMN lesion no matter if it is of upper or lower limb it will present with flaccid paralysis. A LMN lesion isn't specific for upper limbs and a UMN lesion isn't specific to lower limbs.