物理治療介入對於慢性炎症性脫髓鞘性多發神經病變患者功能恢復之成效：個案報告

The Effects of Physical Therapy Intervention on Functional Recovery for Chronic Inflammatory Demyelinating Polyneuropathy with Tetraparesis: A Case Report

汪千涵(Chien-Han Wang) ； 李庭蓁(Ting-Chen Lee)

《物理治療》 45卷3期 (2020/09) Pp. 225-233

https://doi.org/10.6215/FJPT.202009_45(3).0004

摘要

慢性炎症性脫髓鞘性多發神經病變（chronic inflammatory demyelinating polyneuropathy, CIDP）造成四肢輕癱於臨床上為少見之個案。本篇個案是一位58歲男性，發病後13個月的慢性病患。2016年12月感到漸進式四肢麻與無力，於2017年2月電生理和腦脊髓液檢查確診是慢性脫髓鞘性神經炎，期間接受多次免疫治療、血漿置換，於2017年9月開始接受門診物理治療介入，主訴為雙下肢麻且無力，行走不穩。本個案報告將藉由個案處理模式做評估及介入的呈現，並利用「國際功能、失能和健康分類」模式分析發現四肢遠端肌力不足，合併有感覺異常和本體感覺缺失，造成個案在站姿平衡和行走功能的表現上受到影響。而後依據分析結果及參考相關實證設計此個案的肌力訓練，另外也加入視覺回饋平衡訓練儀及行走訓練等介入，改善個案的站立平衡及行走步態。在經過3週短期治療後，不論在平衡或行走功能上皆有顯著進步。個案在伯格氏平衡量表進步6分；計時起走測試進步6.5秒；行走速度進步0.175公尺／秒，均達臨床最小可偵測變化值。經由3週的肌力、視覺回饋平衡訓練及行走功能訓練，有利於改善CIDP造成四肢輕癱患者平衡及行走功能的恢復。

關鍵字

慢性炎症性脫髓鞘性多發神經病變 ； 站姿平衡 ； 行走 ； 物理治療

並列摘要

Tetraparesis caused by chronic inflammatory demyelinating polyneuropathy is uncommon. The case reported in this study was a 58-year-old man whose symptoms were noticed since December, 2016. Insidious numbness and weakness of four extremities were noticed and the symptoms aggravated during walking and carrying heavy objects. He was diagnosed of chronic inflammatory demyelinating polyneuropathy after conducted electrophysiological studies in February, 2017. Later, he underwent treatments of corticosteroids, intravenous immunoglobulin, plasmapheresis and Rituximab. The intervention of physical therapy started on September 8, 2017. The chief complaints of this case were numbness and weakness over bilateral lower extremities. Difficulty in walking was also reported. According to International Classification of Functioning, Disability, and Health model analysis, muscle weakness and impaired sensation and proprioception of the bilateral lower extremities affected this patient's balance performance and walking ability. We designed the treatment programs which included muscle strengthening, ambulation and balance training through the balance performance monitor. After three weeks of intervention, significant improvements in balance and walking ability. There were a 6-point increase in Berg balance scale, a 6.5-second decrease in the Timed Up & Go test, and a 0.175 m/s increase in walking speed. However, no difficience in lower extremity motor score and Barthel Index was found. After 3 weeks of muscle strengthening, walking training and balance training through the balance performance monitor, beneficial effect for patient with tetraparesis caused by chronic inflammatory demyelinating polyneuropathy could be found.

並列關鍵字

Chronic inflammatory demyelinating polyneuropathy ； Standing balance ； Walking ； Physical therapy