Despite clinical intervention, people with chronic inflammatory demyelinating polyneuropathy (CIDP) experience difficulties in gait and balance on a daily basis. However, the effects on these variables of a tailored home based exercise programme for this population have not been investigated.
PURPOSE:
This case series aims to investigate the effects of a home based tailored exercise programme on gait and balance in people with CIDP.
METHODS:
Case series of seven people with CIDP from a neurology department of a local hospital. Participants took part in a 6 week Otago exercise programme, which include walking, strengthening and balance tasks. Participants were assessed 10 times; 3 times prior, 3 times during an exercise intervention, 3 times post intervention and once at three months follow up. The outcome measures were Berg Balance scale, 10 meter walk test, fatigue severity scale and EQ-5D-5L.
RESULTS:
Participants showed an increase in walking speed and balance after the exercise intervention and most kept these improvements at 3 months follow up.
CONCLUSION:
This study shows that exercise can be beneficial for gait and balance in people with CIDP. These findings are in line with literature from related diseases such as Guillain-Barre Syndrome. However studies with a larger sample size are needed to confirm these findings in the population.
LaughlinRS, DyckPJ, MeltonLJ, LeibsonC, RansomJ, DyckPJB. Incidence and prevalence of CIDP and the association of diabetes mellitus. Neurology2009;73(1):39–45.
2.
Van den BerghPY, HaddenRD, BoucheP, CornblathDR, HahnA, IllaI, KoskiCL, LegerJM, Nobile-OrazioE, PollardJ, SommerC, van DoornPA, van SchaikIN. European Federation of Neurological Societies/Peripheral Nerve Society guideline on management of chronic inflammatory demyelinating polyradiculoneuropathy: Report of a joint task force of the European Federation of Neurological Societies [trunc]. Eur J Neurol2010;17(3):356–63.
3.
Van DoomPA, BrandA, StrengersPF. High-dose intravenour mmunoglobulin treatment in Chronic Inflammatory Demyelianting Polyneuropath: A double-blind placebo-controlled, crossover stud. Neurology1990;40:209–12.
4.
HughesRA, DonofrioP, BrilV, DalakasMC, DengC, HannaK, HartungHP, LatovN, MerkiesIS, van Doorn PA; ICE Study Group. Intravenous immune globulin (10% caprylate-chromatography purified) for the treatment of chronic inflammatory demyelinating polyradiculoneuropathy (ICE study): A randomised placebo-controlled trial. Lancet Neurol2008;7(2):136–44.
5.
DyckPJ, O’BrienPC, OviattKF, DinapoliRP, DaubeJR, BartlesonJD, MokriB, SwiftT, LowPA, WindebankAJ. Prednisone improves chronic inflammatory demyelinating polyradiculoneuropathy more than no treatment. Ann Neurol1982;11:136–141, 19.
6.
HughesR, BensaS, WillisonH, Van Den BerghP, ComiG, IllaI, Nobile-OrazioE, Van DoornP, DalakasM, BojarM, SwanA. Randomized controlled trial of intravenous immunoglobulin versus oral prednisolone in chronic inflammatory demyelinating polyradiculoneuropathy. Ann Neurol2001;50:195–201.
7.
DyckPJ. Intravenous Immunoglobulin in chronic inflammatory demyelinating polyradiculoneuropathy and in neuropathy associated with IgM Monoclonal gammopathy of unknown significance. Neurology1990;40:327–8.
8.
WaltonT, VincentM, RichardsJ, DavidsonI. Usefulness of digital gait analysis for assessing patients with Guillain-Barre syndrome. International Journal of Therapy and Rehabilitation2005;12(9):388–93.
9.
KhanF, PallantJF, AmatyaB, NgL, GorelikA, BrandC. Outcomes of high- and low-intensity rehabilitation programme for persons in chronic phase after Guillain-Barré syndrome: A randomized controlled trial. J Rehabil Med2011;43(7):638–46.
10.
FisherTB, StevensJE. Rehabilitation of a marathon runner with Guillain-Barré syndrome. J Neurol Phys Ther2008;32(4):203–9.
11.
RichardsonJK, SandmanD, VelaS. A focused exercise regimen improves clinical measures of balance in patients with peripheral neuropathy. Arch Phys Med Rehabil2001;82(2):205–9.
12.
GarssenMP, BussmannJB, SchmitzPI, ZandenbergenA, WelterTG, MerkiesIS. Physical training and fatigue, fitness and quality of life in Guillain-Barre syndrome and CIDP. Neurology2004;63:2393–5.
13.
WhiteCM, HaddenRD, Robert-LewisSF, McCronePR, PettyJL. Observer blind randomised controlled trial of a tailored home exercise programme versus usual care in people with stable inflammatory immune mediated neuropathy. BMC Neurol2015;15:147.
14.
GrahamRC, HughesRA, WhiteCM. A prospective study of physiotherapist prescribed community based exercise in inflammatory peripheral neuropathy. J Neurol2007;254(2):228–35.
15.
BussmannJB, GarssenMP, van DoornPA, StamHJ. Analysing the favourable effects of physical exercise: Relationships between physical fitness, fatigue and functioning in Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy. J Rehabil Med2007;39(2):121–5.
16.
ChongDY, GlickmanLB, Cabanero-JohnsonPS. Chronic Inflammatory Demyelinating Polyradiculoneuropathy from a Physical Therapist’s perspective: A case report. Journal of Acute Care Physical Therapy2010;1(1):4–13.
17.
BergK, Wood-DauphineeS, WilliamsJI, GaytonD. Measuring balance in the elderly: Preliminary development of an instrument. Physiotherapy Canada1989;41:304–11.
18.
BergK, Wood-DauphineeS, WilliamsJI, MakiB. Measuring balance in the elderly: Validation of an instrument. Can J Pub Health1992;(supplement 2):S7–11.
19.
KruppLB, LaRoccaNG, Muir-NashJ, SteinbergAD. The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol1989;46(10):1121–3.
20.
EuroQol Group. EuroQol–a new facility for the measurement of health-related quality of life. Health Policy1990;16(3):199–208.
21.
PereraS, ModySH, WoodmanRC, StudenskiSA. Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc2006;54(5):743–9.
22.
ConradssonM, Lundin-OlssonL, LindelöfN, LittbrandH, MalmqvistL, GustafsonY, RosendahlE. Berg balance scale: Intrarater test-retest reliability among older people dependent in activities of daily living and living in residential care facilities. Phys Ther2007;87(9):1155–63.
23.
CampbellAJ, RobertsonMC, GardnerMM, NortonRN, TilyardMW, BuchnerDM. Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. BMJ1997;315(7115):1065–9.
24.
BrusseKJ, ZimdarsS, ZalewskiKR, SteffenTM. Testing functional performance in people with Parkinson disease. Phys Ther2005;85(2):134–41.
25.
WirzM, MüllerR, BastiaenenC. Falls in persons with spinal cord injury: Validity and reliability of the Berg Balance Scale. Neurorehabil Neural Repair2010;24(1):70–7.
26.
WangCH, HsuehIP, SheuCF, YaoG, HsiehCL. Psychometric properties of 2 simplified 3-level balance scales used for patients with stroke. Phys Ther2004;84(5):430–8.
27.
BlumL, Korner-BitenskyN. Usefulness of the Berg Balance Scale in stroke rehabilitation: A systematic review. Phys Ther2008;88(5):559–66.
