Amy J. Litterini
© 2018 Alyssa Deardorff
Background: The use of corticosteroids to treat chronic graft-versus-host-disease (cGVHD) is common in oncological treatment. However, the long-term complications of cGVHD and prolonged use of corticosteroids have not been reported in terms of the benefits of physical therapy (PT) interventions. The purpose of this case report was to report the impact of PT interventions for an individual with a cancer diagnosis having received an allogenic-stem cell transplant (allo-SCT) with the long-term complications associated with cGVHD, long-term corticosteroid use, and cancer survivorship. Case Description: The patient was a 73-year-old male diagnosed with Myelodysplastic Syndrome and received an allo-SCT two years prior to initial evaluation. After a multitude of tests, his primary diagnosis was paraplegia with unclear etiology. The patient had weakness in his bilateral lower extremity’s proximal musculature (right lower extremity greater impaired than left) and loss of bowel/bladder function. The proposed plan of care included therapeutic exercise, neuromuscular re-education, self-care/home management, and gait training. Outcomes: After receiving both corticosteroid and PT interventions, the patient increased strength and mobility as shown by his improvement with transfers (Functional Independence Measure score from 4 to 6), gait (distance from 2 feet to 850 feet), and ability to complete balance and strength exercises consecutively and independently. He was discharged with the ability to walk with an assistive device and navigate his home and community environments safely. Discussion: Despite the lack of evidence for therapeutic interventions in patients with chronic corticosteroid use, cGVHD, and allo-SCT patients, this specific example shows the progress and accomplishments one can make with PT to optimize functional independence. Future research requires a greater focus on long-term complications and management of allo-SCTs including rehabilitation.
Deardorff, Alyssa, "Functional Mobility For A Patient With Myelodysplastic Syndrome, Chronic GVHD, And Corticosteroid Use: A Case Report" (2018). Case Report Papers. 97.