Longitudinal gait assessment in a stiff person syndrome.

Stiff person syndrome (SPS) is an autoimmune disorder with multiple clinical presentations, all characterized by generalized or focal muscular stiffness leading to abnormal postures and movements. To date, no standardized treatments are available; also, the outcome measures are mainly clinical based and unstandardized, limiting the reliability of clinical trials. In this case study, we used the eight-camera motion capture system for gait analysis (GA) to outline the gait features and track the clinical evolution of a young patient with SPS receiving a personalized multimodal therapy. GA was accurate in reflecting clinical changes over a 7-week-long period, thus representing a potential source for objective biomarkers in SPS. Therefore, future studies focusing on either the natural history or the treatment of SPS could adopt GA for reliable outocome measures, confirming this preliminary observation.

Paraneoplastic stiff person syndrome: Inpatient rehabilitation outcomes of a rare disease from two cancer rehabilitation programmes.

Paraneoplastic stiff person syndrome is a rare, but debilitating, manifestation of cancer, characterized by painful extremities, truncal and facial spasms. The resultant functional impairment may necessitate comprehensive rehabilitation and symptom management. This case series describes the acute inpatient rehabilitation courses of 2 patients at different tertiary care referral cancer rehabilitation programmes, including work-up and diagnosis, medical management of symptoms, and functional outcomes. Both patients had a reduction in symptom burden and an improvement in motor function as a result of multidisciplinary acute inpatient rehabilitation.

Reducing excess stiffness in Stiff Person Syndrome using CBT: A case study.

BACKGROUND: Stiff Person Syndrome (SPS) is a rare neurological condition, characterised by rigidity in the trunk and limbs. Comorbid anxiety is common and known to exacerbate stiffness. OBJECTIVE: This case study examines the extent to which psychological treatment of comorbid anxiety alleviated stiffness in a patient whose condition was exacerbated by social anxiety. METHODS: A patient was treated using cognitive behavioural therapy, focussing on reducing anxiety and therefore stiffness by addressing rumination, self-focussed attention, and distressing cognitions relating to walking in public. The patient's walking, stiffness, and anxiety were assessed during and post-therapy using questionnaires. RESULTS: Walking, stiffness, and anxiety improved during treatment. At five months' follow up, while the improvement in anxiety was maintained, walking and stiffness had deteriorated. The patient and his Neurologist felt that this deterioration was biological, rather than psychological in nature. CONCLUSIONS: This is the first published case where SPS has been ameliorated (albeit temporarily) using psychological therapy, and has important implications for future research and treatment.

Physical therapist management of stiff person syndrome in a 24-year-old woman.

BACKGROUND AND PURPOSE: Stiff person syndrome is a rare neurological disorder characterized by stiffness and painful spasms primarily in the trunk and lower extremities. The role of physical therapy in the management of this disorder is disputed and the efficacy of specific interventions is unknown. CASE DESCRIPTION: The patient was a 24-year-old woman with a 1-year history of stiff person syndrome who received outpatient physical therapy over the course of 15 weeks. She had pain, muscle spasms, gait anomalies, and range-of-motion deficits, which affected her left lower extremity. Physical therapy interventions consisted of ultrasound, soft tissue mobilizations, manual stretching, and exercise. She also was fitted for a custom-made ankle-foot orthosis. Outcome This patient showed decreased pain and muscle spasms, as well as improvements in gait and range of motion. DISCUSSION: Stiffness and spasms interfere with the ability of these patients to fully mobilize affected joints, and they are at risk of developing further complications. Physical therapy may have a role in the management of this disease, as these patients need to be taught how to properly stretch and maintain joint mobility as a lifelong commitment.

Physical therapy during in-patient rehabilitation for a patient with Stiff-Person Syndrome.

BACKGROUND AND PURPOSE: Patients with Stiff-Person Syndrome (SPS) typically show stiffness and spasms, primarily of the trunk and proximal lower extremities. The purpose of this case report is to provide an overview of SPS and a description of the specific physical therapy management strategies used during a brief inpatient rehabilitation stay for a patient with SPS, illustrating the use of the patient/client management model in the Guide to Physical Therapist Practice. CASE DESCRIPTION: The patient was a 33-year-old with a 3- year history of SPS. He spent 10 days in an in-patient rehabilitation hospital where he received physical therapy daily. The initial examination revealed impairments of pain, range of motion, reflex integrity, and motor function, along with abnormalities of posture, balance, and function. The procedural interventions included therapeutic exercise and functional retraining. Stretching exercises were categorized according to their priority and level of difficulty to accommodate for the patient's varying symptoms, and relaxation exercises aimed to reduce the severity of the patient's spasms. The functional retraining program included transfer and progressive gait training. OUTCOMES: The patient showed improvements in ankle range of motion, posture, and gait (distance, speed, and independence), despite continued problems with stiffness, spasms, and pain. DISCUSSION: Physical therapists working with patients with SPS have challenges related to the paucity of information in the literature. The chronic, progressive, and variable nature of SPS indicates the need for life-long management, with the inclusion of an exercise program that can be adjusted accordingly, given the frequently changing symptoms experienced by the patient. As is shown with this case, it appears that physical therapy can improve function and some of the impairments associated with SPS.

Tratamiento conservador del síndrome de hombro rígido: experiencia con técnica de mio-relajación selectiva / Conservative treatment for rigid shoulder: experience with the technique of selective mio-relaxation

El objetivo del presente trabajo de investigación es demostrar la utilidad de la técnica de mio-relajación selectiva en el tratamiento conservador del síndrome de hombro rígido. Se diseño un ensayo clínico no controlado, ya que no fue posible aleatorizar la muestra, se trataron pacientes con síndrome de hombro rígido mediante la técnica de bloqueo interescalénico con la infiltración de una mezcla de bupivacaína y agua bidestilada. Se realizaron mediciones del grado de dolor y del incremento en los arcos de movimiento después del procedimiento; se estimaron frecuencias, porcentajes y promedio. Se trataron 70 pacientes, 42 femeninos y 28 masculinos; después del procedimiento 39 pacientes se reportaron asintomáticos y los 31 restantes con algún grado de dolor, todos los pacientes mejoraron, la recuperación en la movilidad fue excelente en 32 casos. El bloqueo interescalénico asociado a la movilización activa asistida, mostró ser un método adecuado en el tratamiento del síndrome de hombro rígido