Physical therapy for a patient with polyneuropathy and cognitive deficits from dry beriberi: case report.
Source: PubMed, NCBI / U.S. National Library of Medicine
Dry beriberi presents with peripheral polyneuropathy, cognitive deficits, and functional decline that warrant physical therapy. The purpose of this report is to describe the clinical presentation and physical therapy management of a patient with dry beriberi, highlighting the role of neuroplasticity and motor learning strategies. A 36-year-old female transferred to inpatient rehabilitation. Evaluation revealed cognitive deficits inconsistent with the admitting diagnosis, Guillain-Barré. A medical workup identified thiamine deficiency, suggesting dry beriberi, consistent with her sensorimotor polyneuropathy and impairments in attention, memory, and executive function. Her history of alcohol abuse further supported the dry beriberi diagnosis. She received physical therapy across 26 days in inpatient rehabilitation. Motor learning was promoted through the manipulation of practice conditions, feedback, and implicit processes to maximize mobility gains despite cognitive deficits. Repetition and salience were prioritized during task-specific mobility practice to promote neuroplasticity. Psychosocial factors impacted progress and clinical decision-making. Initially, she required over 50% assistance for all mobility. At discharge, she was modified independent with bed and wheelchair mobility. She required supervision for level and moderate assistance for unlevel slide board transfers, minimal assistance for floor transfers, and total assistance for walking. The Berg Balan
Abstract
Dry beriberi presents with peripheral polyneuropathy, cognitive deficits, and functional decline that warrant physical therapy. The purpose of this report is to describe the clinical presentation and physical therapy management of a patient with dry beriberi, highlighting the role of neuroplasticity and motor learning strategies. A 36-year-old female transferred to inpatient rehabilitation. Evaluation revealed cognitive deficits inconsistent with the admitting diagnosis, Guillain-Barré. A medical workup identified thiamine deficiency, suggesting dry beriberi, consistent with her sensorimotor polyneuropathy and impairments in attention, memory, and executive function. Her history of alcohol abuse further supported the dry beriberi diagnosis. She received physical therapy across 26 days in inpatient rehabilitation. Motor learning was promoted through the manipulation of practice conditions, feedback, and implicit processes to maximize mobility gains despite cognitive deficits. Repetition and salience were prioritized during task-specific mobility practice to promote neuroplasticity. Psychosocial factors impacted progress and clinical decision-making. Initially, she required over 50% assistance for all mobility. At discharge, she was modified independent with bed and wheelchair mobility. She required supervision for level and moderate assistance for unlevel slide board transfers, minimal assistance for floor transfers, and total assistance for walking. The Berg Balance Scale increased from 2/56 to 6/56, indicating a high fall risk in standing, with good sitting balance indicated by 53/56 at the final Function in Sitting Test. The Six-Minute Push Test improved from 52 to 133 meters. The Wheelchair Propulsion Test improved from 0.52 to 0.64 m/s. She could neither return to her job nor live in her second-floor apartment; thus, discharge was to her family's ramp-accessible home. Despite the lack of diagnosis-specific physical therapy guidelines, a patient with dry beriberi-related deficits benefited from task-specific practice incorporating neuroplasticity and motor learning principles to learn compensatory movement strategies while she was unable to restore prior mobility methods.