Chronic Inflammatory Demyelinating Polyneuropathy By: Kyle Leato, SPTA

OBJECTIVES Provide background information Clinical Presentation Cause Treatment Importance to Physical Therapy Conclusion

Background Information What is CIDP? – It is a common, under diagnosed immune-mediated inflammatory disorder of the peripheral nervous system. (Hartung, et al., 2005) Commonly referred to as: – chronic relapsing polyneuropathy Closely related to: – Guillain-Barré syndrome. Prevalence: – 0.5 out of 100,000 children – 1-2 per 100,000 adults

CIDP vs. Guillain-Barré

Cause The body’s immune system attacks the nerves in the periphery, affecting the limbs and organs of the body (Forsberg, Press & Westblad, 2009)

Symptoms Occurrence of symmetrical weakness in both proximal and distal muscles that progressively increases for more than 2 months. Impaired sensation, burning and weakness ( generally occurring in the feet first and they gradually ascend to involve other parts of the body). Absent or diminished tendon reflexes. Elevated CSF protein level. Signs of demyelination (in nerve biopsy specimens). Foot drop. When organs become involved: inability to adequately empty the bladder, nausea, vomiting, abdominal fullness or bloating, diarrhea, or constipation, low blood with dizziness, or trouble maintaining an erection. ****The severity and the combination of symptoms vary for each patient.

Treatment Early Stages: – Typically PROM and positioning is used. – Family Education Middle Stages: – Tactile re-training (brushing, vibration and tapping) – Light resistive exercises – PNF if the patient is capable Late Stages: – Transfer Training – Gait Training with the use of an AD – Progressive Resistive Exercises

Other Treatment Ideas Land Based Exercising: – Alter G Treadmill for reduced body weight walking. Increased weight bearing over a period of time is shown to increase strength and the ability to ambulate independently. (Greenwood & Tuckey, 2004) Water Based Exercise: – Hydro Physio Underwater Treadmill can be altered by increasing or decreasing the amount of water in the tank. – Aquatic therapy has shown to be very beneficial to one of our own patients.

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Importance in Relation to Physical Therapy What can we as a physical therapy team do? – Be prepared to treat the patient on a day-to-day basis because every day can be a day of progression and/or setbacks. Be ready for anything. – Interdisciplinary communication between medical team, occupational therapy and speech therapy. – We can provide education for the patients and their support systems. – Maintain a positive attitude and optimistic outlook. – MOVEMENT IS THE BEST MEDICINE!

Conclusion It’s important to know that CIDP is a unique diagnosis to each and every patient. (Barohn, et al., 2010) No treatment will be the same, therefore it is important to be aware of their past history, their past and current symptoms, as well as their current lifestyle. There is no specific “cure” that physical therapy can provide, so we make it a goal to use the techniques, exercises and knowledge that we have in order to best improve the quality of the life of the patient.

References Barohn, et al. Chronic Inflammatory Demylinating Polyneuropathy Disease Activity Status: Recommendations for Clinical Research Standards and Use In Clinical Practice. Journal of the Peripheral Nervous System. 2010; 15(4): Forsberg A, Press R, Westblad ME. Disability and health status in patients with chronic infammatory demyelinating polyneuropathy. Disability & Rehabilitation. 2009; 31(9): Greenwood R, Tuckey J. Rehabilitation after severe Guillain-Barré syndrome: the use of partial body weight support. Physiotherapy Research International. 2004; 9(2): Hartung H, Jander S, Kieseier BC, Köller H. Chronic inflammatory demyelinating polyneuropathy. N Engl J Med. 2005; 352: