Title : Multidisciplinary rehabilitation management in a patient with Stiff Person Syndrome (SPS): A case study
Abstract:
Stiff Person Syndrome (SPS) is a rare autoimmune condition characterized by the inhibition of Gamma-AminoButyric Acid (GABA) resulting in progressive rigidity, painful spasms and ambulatory dysfunction, all of which substantially increase the risk of falls and decrease quality of life. Although medications like muscles relaxers remain first-line for symptomatic management, these agents can exacerbate fall risk through increased sedation and cognitive side effects. Given these challenges, a multidisciplinary rehabilitation program is paramount in the treatment of SPS, although underreported in the literature. While there is no cure for SPS and spontaneous recovery is rare, early recognition and implementation of a comprehensive rehabilitation treatment plan is crucial to minimize disability and maximize function. This case illustrates a structured multidisciplinary approach to a person living with SPS.
Case: NM is a 37-year-old man with anti- Glutamic Acid Decarboxylase(GAD) antibody-positive SPS manifesting with severe axial stiffness, frequent falls, and poor balance. A multidisciplinary team was created by the leading Physiatrist comprising of Neurology, Rheumatology, Orthotics, Speech Language Therapy, Occupational Therapy and Physical Therapy. An individualized treatment plan consisted of immunotherapy with IntraVenous ImmunoGlobulin (IVIG), symptomatic pharmacological management with muscle relaxers as well as Botulinum Toxin, and psychosocial therapy. Based on patient-specific goals, implemented interventions included task-specific gait training, use of spinal and knee orthoses, dry needling, cognitive behavioral therapy, swallow exercises, and postural training.
Outcomes: Time Up and Go Test (Initial score 15.4 seconds, Interim 12.45 seconds) and Five Time Sit to Stand (Initial 25.42 seconds, Interim 22.92 seconds) improved. Active shoulder flexion was not increased.
Swallow strategies were successful with no reports of aspiration pneumonia. The patient continued to live independently in the home.
Conclusion: This case supports a multidisciplinary rehabilitation in SPS to optimize function and independence. Further studies should explore standardized rehab protocols for SPS.
