A Community-dwelling Older Adult with Concurrent Human Immunodeficiency Virus, Type 1 Diabetes Mellitus and Peripheral Neuropathy: A Case Report.

Abstract

Background: Peripheral neuropathy (PN) may be idiopathic, iatrogenic, or be caused by any number of chronic diseases such as human immunodeficiency virus (HIV) and type 1 diabetes mellitus (DM1). PN is of particular interest to physical therapists, because it contributes to an individual’s risk of falling. Purpose: (1) To describe a community-dwelling older adult with HIV, DM1, PN, and neurotoxic medication use (2) Highlight the pathophysiology of each diagnoses and resulting neuropathy and describe their effect on clinical decision-making when they are both present. Case Description: A seventy-two year-old man presented to outpatient physical therapy with PN and concurrent HIV and DM1. Physical examination identified decreased somatosensation and proprioception amongst other findings. Based on Functional Reach Test (FRT) and the Activities-Specific Balance Confidence Scale (ABC) fall risk cutoff scores, he was at risk of falling. Due to his PN, he was hindered in his ability to maintain balance in low-light situations, traverse stairs with objects in hand, and navigate crowded spaces while traveling and taking photographs. Intervention included balance-challenging neuromotor exercises, progressing in difficulty, and including static, dynamic, anticipatory, and reactive balance interventions. Outcomes: Despite chronic health conditions, the patient experienced meaningful improvements in balance ability and balance confidence. Over 5 sessions of physical therapy in 7 weeks, he improved his scores and was no longer a fall risk on the FRT and ABC. Discussion: PN may be the result of a single diagnosis, or multiple concurrent diagnoses. Studies are much more likely to include individuals with PN from a single source, as opposed to multiple concurrent diagnoses. In the presence of multiple etiologies, it is difficult to determine the best physical therapy intervention approach. Areas for future research may take two directions: (1) Including patients with coexisting conditions in trials (2) Stratification with very clear description of diagnoses in studies seeking optimal examination and intervention approaches. Conclusion: In the absence of clearer guidelines and stratification, an understanding of pathophysiology, patient goals and expectations, and preliminary published evidence should be used to develop an individualized approach to evaluating and treating individuals with PN.