Abstract
HISTORY: A 65 year old woman, diagnosed with Multiple Sclerosis 30 years ago, received treatment for neurologic, orthopaedic, and functional manifestations of the disease >20 yrs. Desired to regain ability to walk in public using an assistive device (Independent Limited Community Ambulation). PHYSICAL EXAMINATION: Presented with severe weakness lower extremities bilaterally Significant balance disturbances due to weakness Lacked dorsiflexion during gait Prescribed NMES unit to attain dorsiflexion, unit failed to elicit any response in involved musculature DIFFERENTIAL DIAGNOSIS: Long standing remitting-relapsing MS TEST AND RESULTS: Manual Muscle Test (MMT): Ankle PF/DF: 0/5 5 times sit to stand: unable unless seat height is increased, with hand hold stabilization Gait: MinA ModA: 7.5 - 15 m Maximum FINAL WORKING DIAGNOSIS: Remitting-relapsing MS, severe weakness, gait and balance disturbances TREATMENT AND OUTCOMES: Lower extremity exercise program using the principles of Dynamic Neuromuscular Stabilization Sit to stand w/o hand hold assist > 15x Gait: Contact Guard, MinA >= 120 m MMT: Ankle PF/DF: 3-/5 Walks with assistive device in public: Independent Limited Community Ambulation
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