米勒費雪症候群患者物理治療介入之臨床效果－個案報告

The Clinical Effect of Physical Therapy Intervention in a Patient with Miller Fisher Syndrome-Case Report

張瑋玲(Wei-Ling Chang) ； 廖淑芬(Su-Fen Liao) ； 陳柏亦(Po-Yi Chen) ； 周雅惠(Ya-Hui Chou)

《物理治療》 42卷4期 (2017/12) Pp. 306-315

https://doi.org/10.6215/FJPT.201712_42(4).0006

摘要

背景和目的：米勒費雪症候群是格林—巴利症候群的變異型態。臨床上常見的症狀有喪失深部肌腱反射、共濟失調、眼肌麻痺。在物理治療臨床經驗上是非常有限的。本篇研究目的在呈現一位米勒費雪症候群的患者，執行個別化運動訓練後的效果。方法：一位77歲男性有軀幹共濟失調，意向動作震顫，缺少深部肌腱反射及延髓麻痺，被醫生診斷為米勒費雪症候群。我們使用柏格式平衡分數量表、修改版國際協調共濟失能評估量表和功能獨立量表來評估平衡、共濟失調及日常功能；運動訓練包括動態站姿平衡訓練、協調訓練及功能訓練，最後我們記錄運動訓練前後的生理評估測試。結果：利用國際健康功能與身心障礙分類系統分析個案問題，發現有軀幹共濟失調、站姿平衡不足及步態不穩等問題。在6週的個別化運動訓練後，不論是修改版國際協調共濟失能評估量表、柏格式平衡分數量表及功能獨立量表分數均有進步。結論：米勒費雪症候群患者接受6週個別化物理治療訓練後可以改善其行走能力、平衡及減少共濟失調。

關鍵字

米勒費雪症候群 ； 物理治療 ； 共濟失調

並列摘要

Background and Purpose: Miller Fisher syndrome is a variant Guillain-Barré syndrome, and is clinically defined by a triad of symptoms, namely: areflexia, ataxia, and ophthalmoparesis. It is rare and lack of clinical evidence to support physical therapy intervention. The purpose of this study is to present the effect of individual exercise training program in a patient with Miller Fisher syndrome. Methods: A 77-year-old man presented with trunk ataxia, intentional tremor, absent deep tendon refl ex, and bulbar palsy was referred to physical therapy department. Miller Fisher syndrome was diagnosed after serial examinations. We used Berg balance scale (BBS), Modified International Cooperative Ataxia Rating Scale (MICARS) and Functional Independence Measure (FIM) to assess the balance, ataxia and functional ability. Training program included dynamic standing balance training, coordination training, and functional ability training. We recorded the data of physical examination before and after exercise training. Results: With the analysis of international classification of functioning, disability, and health model, we found the main problems included trunk ataxia, insufficient standing balance and unsteady gait. After 6 weeks of individual training program, MICARS, BBS and FIM scale were improved. Conclusions: Patients with Miller Fisher syndrome could improve their walking ability, balance and reduce ataxia after six weeks of individualized physical therapy training.

並列關鍵字

Miller Fisher syndrome ； Physical therapy ； Ataxia