Use of Weighted Exercise and Gait Training To Improve Function in the Ataxic Patient: A Case Study on a Patient with Acute Motor-Sensory Axonal Neuropathy

Abstract

Background: Acute motor-sensory axonal neuropathy (AMSAN) is a rare subtype of Guillain Barre Syndrome (GBS) accounting for 3-5% of cases. Common symptoms include impaired joint proprioception, ataxia, and weakness. Treatment includes medication and physical therapy (PT). Research is limited on PT protocols for management of this condition, specifically for treatment of ataxia. Objective: This case demonstrates the effectiveness of weighted exercise and gait training in an ataxic patient with AMSAN in an inpatient rehabilitation unit. Methods: Patient participated in a typical acute inpatient rehabilitation program. In addition, treatment incorporated 2-3lb ankle weights for proprioceptive feedback during supine, sitting, standing, and gait tasks starting week two of rehab stay. At week six ankle weights were removed for all training. Progress was tracked weekly via joint proprioception assessment, FIM scores, and assistance required for functional mobility. Results and Discussion: Patient completed eight weeks of intensive rehabilitation. Patient made significant improvements in proprioception of bilateral great toes, hips, ankles, and knees. Patient’s FIM scores progressed from dependent (0/1) to supervision level (5). This case suggests use of weighted exercise can effectively improve ataxia and functional independence in a patient with AMSAN. Using weights to improve proprioception and ataxia in populations such as multiple sclerosis has been documented however further research is needed in the GBS/ AMSAN population.