An Intervention to Overcome Locomotion Difficulties in a Patient with Oculomotor Nerve Palsy: A Case Study

Abstract

: Introduction: Diplopia due to restricted eye movements makes it difficult to locomote. There are no re ported therapies that overcome the locomotion difficulties of patients with oculomotor nerve palsy after a stroke. We outline a therapy process conducted by an occupational therapist (OT) that combines ptosis therapy and the treatment of impaired eye movements with exploratory activities for locomotion that enabled the patient, a Japanese woman in her 70s, to improve her engagement in daily activities. Methods: The OT therapy consisted of two phases. Phase I: Ptosis and eye movement interventions were performed. Phase II: Interventions supported locomotion that linked visual exploration and the somatosensory system, and the ex perienced locomotion was adapted to the environmental structure. The outcomes for the intervention effects were the degree of ptosis, eye movement and diplopia, gait functions, and a functional independence measure for activities of daily living. Results: The patient's ptosis and eye movement disorder improved, and the difficulty of locomotion due to diplopia was overcome. She was thus able to become independent in all daily activities. Conclusion: Therapy that combines interventions for ptosis and eye movement with exploratory activities supporting locomotion have overcome locomotion difficulties and improved the outcomes of patients with oculomotor nerve palsy. Current interventions may improve locomotion in post-stroke patients with oculomotor nerve palsy. Our findings led us to hypothesize that locomotion difficulties in patients with diplopia due to oculomotor nerve palsy can be overcome by combined therapy for ptosis and eye movements with support for exploratory action in locomotion.