Neurology and Neurosurgery

Acute motor-sensory axonal neuropathy (AMSAN) is a rare subtype of Guillian Barre Syndrome (GBS) accounting for 3-5% of cases. Symptoms include impaired joint proprioception and ataxia. Treatment includes medication and physical therapy (PT), with limited research on PT protocols. This case demonstrates the effectiveness of weighted exercise and gait training in an ataxic patient with AMSAN in an inpatient rehabilitation unit. Patient is a 40yo female with AMSAN initially treated with plasmapheresis and IVIG prior to admission to rehabilitation. Physical therapy presented with bilateral extremity

ataxia, weakness and impaired proprioception and sensation in all extremities. Patient received daily 60-90 minute PT sessions for seven weeks. Patient initially required a 3-person assist for transfers and was unable to ambulate. Week one focused on frenkel exercises and beasy-board transfers. Weighted exercise started on week two with 3 lb ankle weights (AW) for proprioceptive feedback, starting with standing weight-shifting and seated multidirectional toe taps. This progressed to pregait exercises including standing marching and toe taps onto a step with body weight support (BWS). This advanced to gait

training over-ground with BWS and RW. At week 6 AW were removed for all training. By discharge patient was independent with bed mobility, supervision with RW for transfers, and ambulating 160 ft. There is evidence on using weights to improve proprioception and ataxia in populations such as multiple sclerosis, and further research is needed in the GBS/AMSAN population. This case describes a PT protocol that can effectively improve functional independence in AMSAN patient with ataxia.