THE REHABILITATIVE MANAGEMENT OF ACUTE SEVERE COMBINED DEMYELINATION - A CASE-REPORT

Demyelination involving both the peripheral and central nervous system , seen with Acute Severe Combined Demyelination, results in a combinat ion of the deficits from Acute Inflammatory Demyelinating Polyneuropat hy and Acute Disseminated Encephalomyelitis. The unique medical, physi cal, psychosocial and functional challenges this disorder presents to the rehabilitation team have not been described. A-70-year old individ ual with a 3-week course of ascending paralysis, dysesthesias, urinary retention, insomnia and cognitive deficits is presented. An individua lized program of rehabilitation entailing principles of spinal cord in jury, brain injury and geriatric rehabilitation was implemented. Signi ficant improvements in upper extremity weakness, pain, bladder control , sleep disturbance and cognition were achieved, however, lower extrem ity weakness and truncal control deficits remained after a 10-week reh abilitation program. This case report describes the rehabilitative man agement of an adult with Acute Severe Combined Demyelination, highligh ting the unique aspects of intervention. (C) 1997 Elsevier Science Ire land Ltd.