Faculty Advisor(s)

Matthew Somma

Document Type

Course Paper

Publication Date



© 2018 Derek Schwaiger


Background and Purpose: Progressive Multifocal Leukoencephalopathy (PML) is a demyelinating disease affecting patients with compromised immune systems. It attacks the central nervous system through white matter plaques that destroy neurons. Plaques form due to the John Cunningham Virus (JCV). There is no approved JCV treatment and thus, no treatment for PML. The purpose of this case report is to examine the physical therapy interventions administered to a patient with PML to address low back pain and functional mobility deficits. Case Description: The patient chosen was a 51-year-old male referred to outpatient physical therapy services with a medical diagnosis of PML. His referral to outpatient physical therapy was for low back pain, gait and balance deficits, and right-sided hemiparesis. He was independently living at home prior to starting therapy. Orthopedic Manual Physical Therapy (OMPT) was utilized in combination with progressive strength and neuromuscular re-education training over 13 visits spanning 5 weeks, to target the patient’s low back pain and functional mobility deficits. Outcomes: The patient’s low back pain decreased from 7/10 using the visual analog scale (VAS) to 0/10 at discharge. The Timed Up and Go Test (TUG) score remained 35 seconds. Self-reported scores using FOTO improved by 10 points. The patient’s lower extremity (LE) range of Motion (ROM) values also improved. Discussion: The combination of orthopedic manual therapy, strength training, and neuromuscular re-education appears to have decreased the patient’s pain on the VAS and improved his LE ROM. The patient experienced no improvements in functional mobility according to the TUG scores. Testing was limited, however, by the progressive nature of his condition. Further research is indicated for people with this condition to determine if interventions exist that can increase functional mobility.


The case report poster for this paper can be found here:




To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.