Case report: physical therapy examination and management of a 39-year-old male with a transtibial amputation and chronic inflammatory demyelinating polyradiculoneuropathy

Abstract Background and Purpose: Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an acquired immune-mediated inflammatory disorder of the peripheral nervous system that occurs in 1.5-3.6 million people per year. Transtibial amputations are more common and can lead to biomechanical and psychological constraints if not treated properly. The purpose of this case report is to provide evidence-based PT examination and management in a patient who presents with a transtibial amputation and CIDP. Case Description: A 39-year-old male was ordered to PT to improve functional mobility with his new active vacuum prosthesis. He presented with sensation impaired in all extremities, deficits in objective and subjective outcome measures, and exemplified balance deficits by having a loss of balance at the evaluation due to decreased toe off and foot clearance on the nonimpaired (right) side. PT plan of care emphasized pain alleviation, therapeutic exercise, gait training, and balance per patient tolerance, of which varied greatly with each PT treatment.
Outcomes: The patient improved in all subjective and objective measures, with available MCID and MDC values being achieved. The patient was on pace to complete all of his goals, but his PT plan of care was furloughed for 30 days due to prosthetic concerns that were unable to be alleviated by PT.
Discussion: PT interventions proved beneficial for this patient, as he was able to ambulate 60ft without an AD as he did prior, thus meeting his personal goal for PT. However, more PT would have proven beneficial in order to increase the distances ambulated in the clinic. Subjective reports varied daily due to his CIDP diagnosis and IVIG infusions, thus experimental research should delve into appropriate interventions and techniques for this population.