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Case report

Exercise intervention leads to functional improvement in a patient with spinal and bulbar muscular atrophy

JoAnne Compo, Jamell Joseph, Vincent Shieh, Angela D. Kokkinis, Ana Acevedo, Kenneth H. Fischbeck, Christopher Grunseich, Joseph A. Shrader
Neurogentics Branch, NINDS, National Institutes of Health, Bethesda, USA
DOI: 10.2340/20030711-1000041

Abstract

Introduction: Spinal and bulbar muscular atrophy is a progressive neuromuscular disease that leads to muscle weakness and reduced physical function. Benefits of physical therapy for people with spinal and bulbar muscular atrophy have not been report-ed in the literature.
Case report: A 62-year-old male patient with spinal and bulbar muscular atrophy reported falling, difficulty walking and completing upright tasks, and showed clinical signs of low baseline function on examination. Transportation challenges made it difficult for this patient to attend frequent one-on-one physical therapy sessions.
Interventions and outcomes: A minimally super-vised home-based exercise intervention was chosen with the goal of safely improving his functional capacity. The 5-visit clinical intervention, spread over 10 months, provided 3 exercise modules: seated-to-standing postural alignment and core muscle activation; upright functional and endurance training; and balance training and rhythmic walking. Post-intervention the patient had increased lower extremity muscle strength, improved balance, and reduced self-reported fatigue.
Conclusion: Home-based exercises were well tol-erated with no increase in creatine kinase. Multiple clinical measures of strength and function improved, possibly related to the patients’ excellent motivation and compliance with the programme. Promising utilization of a minimally supervised home-based programme is described here.

Lay Abstract

Spinal and Bulbar Muscular Atrophy (SBMA) is a progressive neuromuscular disease that leads to weakness, frequent falls, and loss of function. The effects of Physical Therapy for people with SBMA have not been reported. A 62 year old male patient with SBMA reported difficulty walking and completing standing tasks. Transportation challenges made it difficult for him to attend frequent physical therapy sessions. A minimally supervised, home-based exercise program was provided. The program was spread over 10 months and included 5 in-person therapy sessions and 3 exercise modules: seated-to-standing postural and core muscle strengthening; standing functional and endurance training; and balance and rhythmic walking exercises. Afterwards, the patient had increased leg strength, improved balance, and reduced fatigue that was measured objectively. The exercise intervention was deemed helpful and safe by the patient and care providers but required good patient participation, given the minimal supervision provided.

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