8/14/2019 Mulligan Neuro Case Study

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INTRODUCTION

Charcot-Marie-Tooth Disease (CMT) is known for itsslowly progressive symmetrical weakness thatbegins distally creating concurrent functionallosses. While CMTs progression isdocumented, few studies have reported longterm effects of PT interventions.

Purpose :

1. Describe a PT plan of care for an individual withCMT 1A that emphasized motor learning andmotor control while incorporating surfaceelectromyography (sEMG), manual therapy,strengthening, and aerobic conditioning.

2. Illustrate the PTs role as primary care provider for aperson with a chronic neuromuscular disabilityover a 5 year period.

Physical Therapists as Primary Care Providers for Chronic Neuromuscular Disease:A Case Report

Nancy Mulligan PT DPT, Barbara Tschoepe, PT PhD, Marcia Smith, PT PhDSchool of Physical Therapy, Regis University, Denver, CO

DISCUPT care short tefunctioefficac

comprestrategifollow-multipl

INTERVENTIONRetraining of trunk, hip and LE recruitment patterns asthey related to posture, balance and gait

Gait re-education with sEMG and MBT heel rocker shoe

with cane standard shoes without cane and retro TMBalance training: proactive, reactive and stability

HEP for enhanced core control circuit training athealth club

Aerobic conditioning with recumbent bike and TM

Manual therapy for periodic episodes of neck, hip andknee pain

Neurologist, orthopedist, psychologist and sport podiatristreferral

OUTCOMES

sEMG analysis of muscle activation patterns Unopposedfiring of tibialis anterior 2 to no gastroc-soleus activityprogressed to an alternating pattern.

CASE DESCRIPTION

A 52 yo woman recently diagnosedwith CMT 1A

Initial goals:Decrease fatigueComplete job responsibilitiesWalk independently from car to office (3000ft)Improve balance to reduce fall frequency (4 fallsreported over previous year)

PT in a primary care model periodically addressed:Patient goalsBody structure and function impairmentsActivity limitationsParticipation restrictions

EXAMINATIONSystems review moderate cardiovascular risk

Posture and gait analysis significant asymmetries

MMT, ROM, muscle length testing proximal trunk and

distal muscle weakness/length deficitsSurface electromyography (sEMG) analysis of muscleactivation patterns poor muscle onset and offset timing,inappropriate sequencing and low amplitudes throughoutthe gait cycle

Balance no ankle strategies, inappropriate hip andstepping strategies, poor anticipatory responses and poor stability

Functional Outcome Measures PPT-7, sit to stand x 5,gait speed, Patient Specific Functional Scale

DIAGNOSISBalance and gait dysfunction, motor recruitment andstrength deficits associated with CMT

PROGNOSISProgressive disorder with guarded ability to improvefunction

CLINIPT servpatientcare prfunctioconditi

The autfrom boto optim

Patient Specific FunctionalGoals

Activity Goal A chieved

Walk 3000ft to office Safe communityambulation

10 K Walk withoutwalking sticks

2 hours and 18 minutes

Recreat ional Skier Green and Bluediamond ability