Practice of gait training using lower-limb orthosis and body weight-supported walker for severe acute motor axonal neuropathy: a case report.

Abstract

Kikkawa T, Takashima A. Practice of gait training using lower-limb orthosis and body weight-supported walker for severe acute motor axonal neuropathy: a case report. Jpn J Compr Rehabil Sci 2023; 14: 49-53.

Introduction: Acute motor axonal neuropathy (AMAN) requires aggressive gait rehabilitation from the early phase of its onset due to the long time required to achieve independent gait. In this report, we describe the progress of gait training using a combination of lower-limb orthosis and body weight-supported (BWS) walker in a patient with severe AMAN.

Case: A 30-year-olds man diagnosed with AMAN underwent two high-dose intravenous immunoglobulin treatments and combined steroid pulse therapy. The patient was admitted to the convalescent rehabilitation ward for 87 days with a Medical Research Council (MRC) score of 7 points for muscle strength and 13 points for Functional Independence Measure (FIM) motor items. He started gait training with a knee-ankle-foot orthosis on the 128th day. Thereafter, the distance of gait training increased with the use of lower-limb orthosis and BWS walker. At the time of discharge, the patient's MRC score had improved to 24 points and his FIM motor items score to 31 points. He was able to walk 90 m using ankle-foot orthosis and forearm walker and was transferred to a rehabilitation facility on day 237.

Discussion: Gait training with lower-limb orthosis and BWS walker was performed on a patient with severe AMAN. As a result, gait training distance increased without adverse events. Gait training can be performed safely and effectively by combining lower-limb orthosis and BWS walker when gait ability is expected to improve, even in severely ill patients.