Case Study – Multiple Sclerosis

September 3, 2018 | By | Reply READ MORE...

53 year old male, Mr. A is a known case of multiple sclerosis since 11 years presenting with the following chief complaints:

  • Inability to walk without a walking aids since 11 years
  • Difficulty balancing and performing transferring daily activities
  • Walking for more than 10 minutes
  • Weakness on the left side of the body

Past history:

  • Symptoms started with double vision or diplopia. He was unable to focus on one object and could see everything double.
  • Mr A found it difficult to balance and which went on progressing with age.
  • There was an electrical sensation going down the spine occasionally.
  • Found it difficult to walk for more than 10 minutes

Investigations:

  • MRI of the brain-focal thinning of the spinal cord at c3-c4 level with subtle intra medullary hyperintensity. Cervico-medullary junction and rest of spinal cord remain unchanged. Dorsal spine reveals hyperintense area in the D10 level. Multiple ring enhancing lesions in the cervical and dorsal cord.

Evaluation:

Mr A walked with a static ankle foot orthosis (AFO) with shifting his weight to the right side and hiking his hip to clear the ground due to reduced movement at the ankle joint

  • No cranial nerve abnormalities.
  • Superficial sensations were intact
  • Normal superficial and deep reflexes.
  • Generalized reduced muscle strength
  • Dynamic balance affected.
  • Mild foot drop on the left side
  • Reduced shoulder ranges without shoulder blade stabilization
  • Scissoring with reduced heel strike and push off
  • No visual or auditory defect seen
    cs_multiple-sclerosis-01

Plan of care:

  • To improve balance and posture
  • To improve general body strength
  • To improve her gait and coordination

Standing balance training-

  • Weight transfers onto the front, back and sides, narrowing the base of support and giving unstable surfaces
  • Progression- standing with wall support- ball catch and throw.
  • Pertubations in standing as well as reach outs out of base of support was given

Strengthening exercises-

  • Exercise involving all muscle groups was done with enough breaks and more repetitions and holds to improve endurance and reduce fatigue.
  • Shoulder blade stabilization exercises with dynamic arm movements
  • Transfers using the correct strategies were taught
  • Core and buttock work was done with therabands
  • Bridging on gym ball
  • Static cycle
    cs_multiple-sclerosis-02

To improve coordination-

  • Frenkel’s Exercises in various positions

Gait training-

  • Walking with AFO’s
  • Forward and sideways walking with increasing the base of support reduced the scissoring gate.
  • Spot Marching
  • Heel toe walking
    cs_multiple-sclerosis-03

Results:
At the end of 3 months, Mr A started showing improvements in gait and balance with transfers easier than before
We modified his static Ankle foot orthosis to dynamic ankle foot orthosis
His fatigue levels had gone down and could walk for a longer period of time
Better shoulder stability and ranges

At PHYSIOREHAB, we diagnose a condition with detailed assessment by looking at the functional limitations and not just symptoms and thus have a holistic approach to treatment. We strive hard to give the best results to the patient by setting goals per session and achieving each of them at the end of which the quality of life is improved to a great extent.

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Category: Case Studies

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