A hybrid home rehabilitation program for Moyamoya Disease to facilitate return to work and functional independence: A case report from a developing country during the COVID-19 pandemic

@#A 35-year-old female, right-handed, non-hypertensive, and non-diabetic Filipino presented with decreased verbal output and weakness of the right upper and lower extremities during the peak of the COVID-19 pandemic. Cerebral angiography showed bilateral steno-occlusive disease, which was consistent with Moyamoya disease. She underwent inpatient rehabilitation consisting of physical, occupational, and speech therapy. Rehabilitation posthospital discharge was continued using a hybrid rehabilitation approach with a mixed in-person home rehabilitation and remote telerehabilitation. The hybrid approach helped ensure continuity of rehabilitation care, minimize travel and exposure to the hospital or community amid the COVID-19 risks, and reduce costs, without entirely losing the benefits that could only be obtained from hands-on therapeutic evaluation and treatment. After six months of hybrid rehabilitation, the patient was able to return to work and regain functional independence.

A hybrid home rehabilitation program for Moyamoya disease to facilitate return to work and functional independence: A case report from a developing country during the COVID-19 pandemic

@#A 35-year-old female, right-handed, non-hypertensive, and non-diabetic Filipino presented with decreased verbal output and weakness of the right upper and lower extremities during the peak of the COVID-19 pandemic. Cerebral angiography showed bilateral steno-occlusive disease, which was consistent with Moyamoya disease. She underwent inpatient rehabilitation consisting of physical, occupational, and speech therapy. Rehabilitation posthospital discharge was continued using a hybrid rehabilitation approach with a mixed in-person home rehabilitation and remote telerehabilitation. The hybrid approach helped ensure continuity of rehabilitation care, minimize travel and exposure to the hospital or community amid the COVID-19 risks, and reduce costs, without entirely losing the benefits that could only be obtained from hands-on therapeutic evaluation and treatment. After six months of hybrid rehabilitation, the patient was able to return to work and regain functional independence.

Rehabilitación híbrida realizada en paciente con síndrome de Goldenhar. Reporte de un caso / Hybrid rehabilitation conducted in a patient afflicted with Goldenhar's syndrome. Case report

Resumen: El síndrome de Goldenhar en honor al Dr. M. Goldenhar suele reservarse para los casos que presentan microsomía hemifacial. Este síndrome suele afectar principalmente maxilar, mandíbula, pabellón auricular, globo ocular y tejidos adyacentes de una hemicara. El objetivo de esta rehabilitación es devolver en medida de lo posible, la función masticatoria y estética al paciente. A continuación se presenta la rehabilitación intraoral de una paciente con síndrome de Goldenhar que acudió a la clínica de PMF presentando edentulismo total hipoplasia maxilar y mandibular (esta última compensada con una cadena de titanio). Se realizó rehabilitación protésica bimaxilar, teniendo en cuenta la asimetría facial, la limitación de movimiento mandibular y la disminución de los procesos alveolares. El tratamiento fue enfocado principalmente en mejorar la función masticatoria, fonética y estética, que en conjunto son determinantes en la cotidianidad del paciente y su calidad de vida.

Abstract: Goldenhar's syndrome, named after Dr M Goldenhar, is normally reserved for cases presenting hemi-facial microsomy. This syndrome normally affects upper and lower jaws, pinna, and adjacent tissues in a hemi-face. The target of this rehabilitation is to restore to its maximum possible extent patient's esthetics and masticatory function. We present intra-oral rehabilitation of a Goldenhar Syndrome patient who attended the maxillofacial prosthesis clinic. The patient exhibited complete edentulism, maxillary and mandibular hypoplasia (this latter compensated with a titanium chain). Prosthetic bi-maxillary rehabilitation was undertaken, bearing in mind circumstances of facial asymmetry, mandibular movement limitations and decreased alveolar ridges. Treatment was mainly focused on improvement of esthetic, phonetic and masticatory functions, which, as a whole are crucial in patient's day-to-day life and quality of life.