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A 55-year-old female with a past medical history of leukemia, hepatitis C, and liver cirrhosis went to the hospital with progressive low back pain, fatigue, extremity numbness, and generalized weakness. The initial diagnosis made by her primary care physician was sciatica and questionable cancer relapse. Further diagnostic tests during this hospital admission, which included a lumbar puncture and repeated nerve conduction studies, confirmed a diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP). The patient was admitted to the hospital for medical work-up and interventions. Her medical therapy included oral prednisone, plasmapheresis, and intravenous immunoglobulin (IVIg) treatment, lactulose, morphine, pantoprazole, enoxaparin, oxycodone, temazepam, and gabapentin. On hospital admission day 2, the physical therapist is asked to evaluate and treat the patient as well as provide discharge recommendations. The patient was working as an accountant prior to the onset of her symptoms. She lives in a single-story house with her husband, who is available to provide full-time care.

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Based on her health condition including past medical history and onset of present illness, what do you anticipate will be the contributors to activity limitations?

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What are the physical therapy examination priorities?

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What are the most appropriate physical therapy outcome measures?

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What are the most appropriate physical therapy interventions?

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What precautions should be taken during physical therapy examination and interventions?

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What are possible complications interfering with physical therapy?

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  • INTRAVENOUS IMMUNOGLOBULIN (IVIg): Blood product extracted from plasma that contains immunoglobulin antibody G; it is administered intravenously and is commonly used to treat autoimmune diseases or acute infections
  • NERVE CONDUCTION STUDY: Electrical test commonly performed in both sensory and motor nerves that is used to determine the adequacy of the conduction of the nerve impulse

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  1. Describe the medical diagnosis and differential diagnoses of chronic inflammatory demyelinating polyneuropathy (CIDP).

  2. Describe common clinical presentations of CIDP.

  3. Describe commonly used medical interventions for CIDP.

  4. Explain adverse drug reactions (ADRs) of CIDP medical interventions that may affect physical therapy examination and/or interventions.

  5. Describe the importance of combined medical and rehabilitation therapy and interdisciplinary collaboration in the management of CIDP.

  6. List factors that may impact physical therapy prognosis for the patient with CIDP.

  7. Design an appropriate plan of care for the patient with CIDP, taking comorbidities and variable medical course into consideration.

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PT considerations during management of the individual with CIDP:

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  • General physical therapy plan of care/goals: Prevent or minimize loss of range of motion, strength, and aerobic functional capacity; minimize pain and fatigue; maximize functional activity tolerance and safety while minimizing secondary impairments; improve quality of life
  • Physical therapy interventions: Patient and caregiver education regarding functional mobility, prognosis, and physical therapy plan of care; pain management; range of motion and strength training; functional mobility training; ...

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