Date of Award

2016

Document Type

Scholarly Project

Degree Name

Doctor of Physical Therapy (DPT)

Department

Physical Therapy

First Advisor

Michelle LaBrecque

Keywords

Polymyositis -- diagnosis; Polymyositis -- therapy; Case Reports

Abstract

BACKGROUND AND PURPOSE: Polymyositis (PM) is the most common inflammatory myopathy in persons over age 50. It predominantly causes weakness at proximal musculature including the trunk, hips, thighs, shoulders, upper arms, and neck leading to challenges with ambulation and mobility, community activities, and difficulty swallowing, eating, and talking. Studies have shown physical therapy to be a staple in the plan of care for treatment of PM to aid in the restoration of muscle function and to improve or prevent further loss of strength. The purpose of this case report is to outline physical therapy's role in the treatment of a patient who showed both improvement and digression in terms of strength and mobility secondary to polymyositis.

CASE DESCRIPTION: The patient was a 69-year-old female presenting to swing bed physical therapy for weakness and debility secondary to PM. The patient had decreased balance and was unable to independently rise from a chair. She demonstrated 2/5 MMT bilaterally at the hip and shoulder preventing her from being able to complete most ALDs, transferring, and bed mobility. She could ambulate up to 200 feet with SBA for safety but fatigued quickly.

INTERVENTION: The patient was seen for 11 sessions during her 15-day swing bed stay and two to three times per week for three weeks as an outpatient. Physical therapy interventions included task specific full body strengthening and endurance interventions, gait training, balance activities, and as needed manual therapy techniques for pain management. Strengthening included upper extremity assisted ROM at the shoulder, weight resisted UE exercises, assisted hip and knee exercises in supine and/or sitting, weight resisted LE exercises, sit to stands, ambulation for distance, and core-focused rolling and assisted sitting exercises.

OUTCOMES: The patient gained the ability to rise from a lift chair and roll in bed independently. Endurance increased, and she was able to ambulate up to 550 feet with SBA for safety. Upper extremity strength remained unchanged while in swing bed, however as an outpatient strength increased slightly. The patient reported better-perceived tolerance to transfers and demonstrated improved balance. Three weeks into outpatient therapy, she had a reaction to her Prednisone treatments and developed situational diabetes mellitus causing muscle weakness and debility. She was hospitalized for management.

DISCUSSION: The patient had a long and difficult stay at different medical facilities to manage her PM. Even with her unexpected medical difficulties, the patient demonstrated improvement of muscle function, greater in her LEs than UEs. This led to improved functional mobility, improved balance, and improved tolerance to ADLs. This case report outlines the need for further research and suggests that a detailed physical therapy plan of care should be created and driven by functional and ADL specific goals.

Download
COinS