Stiff Person Syndrome: A Case Study
Abstract[edit | edit source]
Introduction[edit | edit source]
Stiff Person Syndrome (SPS) is a rare neurological condition in which the rate of diagnosis is approximately 1 diagnosis for every 1 million people [1]. The low occurrence of the condition may contribute to there being limited research in regard to the effectiveness of a physiotherapy intervention. In individuals who have SPS it is typical to present with a hyper-lordodic posture, rigidity, and fluctuating muscle spasms[2] [3]. The symptoms typically have an insidious onset with increased tone starting in the paraspinals, proximal lower extremities, and abdominal muscles[2] [3]. Individuals with SPS may also present with episodic spasms particularly in the lower limbs that may also have an associated trigger [2][3]. The spasms may also cause the patient to fall like tin-man [3]. The typical differential diagnosis for SPS may differ from patient to patient as symptoms vary but it may include: Multiple sclerosis, Parkinson’s disease, or psychiatric disorders secondary to phobias and emotional triggers[2].
Client Characteristics[edit | edit source]
Mr. Reed is a 75-year-old male. He is a retired data analyst, who lives at home with his wife in Kingston, Ontario. Mr. R began noticing he had decreased balance two and a half years ago with increased amounts of falls (last fall ~two weeks ago) which has progressively gotten worse with low back pain starting a year and a half ago. Within the last year, he noticed increased pain in his lower extremities with muscle spasms particularly affecting the left leg. He was referred to a neurologist and diagnosed with SPS. He received a referral for outpatient physiotherapy to perform a falls risk assessment, help with his balance and gait, manage muscle rigidity and spasms, and maintain his independence and quality of life.
Examination Findings[edit | edit source]
Subjective[edit | edit source]
- Patient Profile (PP): 75 y/o male, right hand dominant
- History of Present Illness (HPI): diagnosed with stiff person syndrome 1 year ago, left plantar flexor contracture (~2 months), muscle spasms, and progressive rigidity (~ 1 year) and lower extremity pain (~6 months), chronic low back pain (~1.5 years).
- Past medical history: Type 1 diabetes, hypertension, high cholesterol.
- Medications: Oral diazepam, gabapentin (1), and insulin
- Health Habits: Non-smoker, drinks occasionally (~2 drinks a week).
- Psychosocial: The patient describes feeling lonely due to COVID-19 as well as frustrated with the diagnosis. Over the past 6 months, he has avoided gardening and groceries due to feeling unsteady and having a fear of falling. He lives with his wife and his son lives 20 minutes away and visits weekly where his daughter lives 1 hour away and visits monthly.
- Home: Bungalow, 5 stairs into the home with railings on the right at both front and back door. The bathroom has a stand-up shower with railings.
- Previous Functional Status: Able to ambulate more than 200m with no gait aid, active in gardening and golfing, no issues performing activities of daily living (ADLs)
- Current Functional Status: Less confident walking outdoors, feeling unsteady, rigidity and painful spasms in both lower extremities prevented him from engaging in his hobbies (gardening, watching golf, sailing)
- Imaging/Diagnostic testing: MRI and X-ray for chronic low back pain (all negative), Blood tests (Anti-GAD body 92.5 units/mL), nerve conduction studies (No abnormalities)
- Precautions/Contraindications: None
- Chief complaint: decreased balance control, increased rigidity and painful spasms in lower extremities particularly in the left leg limiting his ability to do ADLs.
Objective[edit | edit source]
General[edit | edit source]
- Vital signs
- Pulse 80bpm, BP 145/95mm HG, RR 15 bpm
- Pain
- Visual analogue scale
- 3/10 constant pain in the lower back
- 4/10 during painful spasms in the right lower extremity, due to hot weather and stress
- 7/10 during painful spasms in left lower extremities, due to hot weather and stress
- Visual analogue scale
Posture[edit | edit source]
- Thoracic kyphosis
- Hyper-lordosis
Gait[edit | edit source]
Tone[edit | edit source]
- Increased tone in the lower extremities, more increased tone on the left
- Mild plantar flexion contracture, as well as lack of knee extension
AROM[edit | edit source]
PROM[edit | edit source]
Strength[edit | edit source]
Sensation[edit | edit source]
Neurological testing[edit | edit source]
Self-Reported Outcome Measures[edit | edit source]
Outcome Measures[edit | edit source]
Clinical Impressions[edit | edit source]
- ↑ Bhatti AB, Gazali ZA. Recent advances and review on treatment of stiff person syndrome in adults and pediatric patients. Cureus. 2015 Dec;7(12). doi: https://doi.org/10.7759/cureus.427
- ↑ 2.0 2.1 2.2 2.3 Hegyi CA. Physical therapist management of stiff person syndrome in a 24-year-old woman. Physical therapy. 2011 Sep 1;91(9):1403-11. doi: https://doi.org/10.2522/ptj.20100303
- ↑ 3.0 3.1 3.2 3.3 Potter K. Physical therapy during in-patient rehabilitation for a patient with stiff-person syndrome. pre. 2006 Mar 1;30(1):28-38. doi: https://doi.org/10.1097/01.NPT.0000282147.18446.b8