Clinical decision making and application of an active rehabilitation program for a person with the neuromuscular symptoms of Allgrove syndrome: a case report
BACKGROUND:Allgrove syndrome is a multisystem disorder first described in 1978 and is classically associated with esophageal achalasia, alacrima, and adrenal insufficiency. Allgrove syndrome is caused by homozygous and/or compound heterozygous mutations on Chromosome 12q13, designated as "AAA" (Achalasia, Addisonianism Alacrima). AAA encodes the protein ALADIN (Alacrima, Achalasia, aDrenal Insufficiency Neurologic disorder), a member of the nuclear porin family forming the nuclear pore complex. PURPOSE/OBJECTIVE:The purpose of this case report is to illustrate the clinical decision making and results following an active rehabilitation program on a patient with Allgrove syndrome. A detailed physical examination is also provided to contribute to the body of knowledge regarding the clinical presentation of this disorder. CONCLUSION/CONCLUSIONS:It appears that in this case, this patient with Allgrove syndrome demonstrated a significant increase in endurance, balance, and a return to functional activities and participation following a 10-week physical therapy program consisting of task-oriented exercise, aerobic training, postural control exercises, and patient education. Due to the pathophysiology of Allgrove syndrome, these patients cannot be exercised in a traditional manner. It is prudent to perform these interventions with precautions including frequent monitoring of vitals, rest breaks in cool environments, close supervision during balance tasks, and submaximal exercise at a Borg scale of moderate intensity. C.A.'s overall improvements illustrate the potential value of complementing the medical management of persons with Allgrove syndrome with active exercise interventions.
The Effect of Active Physical Training Interventions on Reactive Postural Responses in Older Adults: A Systematic Review
BACKGROUND:A variety of physical interventions have been used to improve reactive balance in older adults. PURPOSE/OBJECTIVE:To summarize the effectiveness of active treatment approaches to improve reactive postural responses in community-dwelling older adults. DESIGN/METHODS:Systematic Review, guided by PRISMA guidelines. STUDY SELECTION/METHODS:A literature search included databases of PubMed, OVID, CINAHL, Clinicaltrials.gov, OTseeker, and PEDro up to December 2017. RCTs that evaluated quantitative measures of reactive postural responses in healthy adults following participation in an active physical training program were included. DATA SYNTHESIS/RESULTS:Of 4,481 studies initially identified, 11 RCTs covering 313 participants were selected for analysis. Study designs were heterogeneous, preventing a quantitative analysis. Nine of the eleven studies reported improvements in reactive postural responses. CONCLUSIONS:Several clinically-feasible training methods have the potential to improve reactive postural responses in older adults; however, conclusions surrounding efficacy of treatment methods are limited due to numerous methodological issues and heterogeneity in outcomes and intervention procedures.
Return to Meaningful Activities After a Multi-Modal Rehabilitation Programme among Individuals Who Experience Persistent Dizziness and Debility Longer Than 9 Months after Sustaining a Concussion: A Case Series
Outcomes Following a Vestibular Rehabilitation and Aerobic Training Program to Address Persistent Post-Concussion Symptoms
PURPOSE: To describe changes in adults with persistent symptoms and disability following a concussion after completing a supervised home exercise vestibular rehabilitation (VR) program combined with aerobic training. METHOD: Participants included 14 consecutive individuals referred for VR within the context of a comprehensive concussion center. Outcome measures were administered at initial evaluation, 3 mos, and 6 mos. Outcome measures included: Rivermead Post-Concussion Questionnaire symptom (RPQ-3) and function (RPQ-13) subcategories, Dizziness Handicap Inventory (DHI), Activities-specific Balance Confidence Scale (ABC), functional gait assessment (FGA), return to work/study (RTW), and return to activity (RTA). RESULTS: At 6 months, all clinical outcome measures were found to be statistically significant or approaching statistical significance: RPQ-3 (p<0.001), RPQ-13 (p<0.004), DHI (p<0.001), ABC (p<0.007), FGA (p<0.001). For return to meaningful activity, associations between time of measure and both RTW (p<0.019) and RTA (p<0.001) were found to be statistically significant or approach statistical significance. CONCLUSION: Following 6 months of participation in a supervised home exercise VR program with aerobic training, significant improvements were observed in participants' report of concussion-related symptoms, function, and return to meaningful activities.
An Integrative Model for the Treatment of Co-Morbid Anxiety and Vestibular Disorder [Meeting Abstract]