Chronic Inflammatory Demyelinating Polyradiculoneuropathy from a Physical Therapist's Perspective: A Case Report

Purpose: Although the literature describes several medical interventions for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), no evidenced-based approaches to rehabilitation specific to CIDP can be found. This case report reviews key background information on CIDP, and describes an interdisciplinary approach to rehabilitation in an acute care setting. It illustrates the use of medical knowledge, clinical reasoning, and evidence in selecting outcome measures, formulating a plan of care, and guiding clinical decisions. Methods: This case describes a 59-year-old man with multiple significant co-morbidities during a six-month period characterized by significant pain, sensory changes, and progressive weakness. He deteriorated dramatically from independent ambulation to requiring a wheelchair. Symptom progression attributed to end-stage liver disease led to further diagnostic tests and eventually, a definitive diagnosis of CIDP. Initial findings included significant major muscle group weakness and a Functional Independence Measure (FIM) score of 23 out of 126. Intervention was focused on therapeutic exercise, balance training, and functional training with progressive endurance activities. FIM score improved to 56, sufficient for discharge to an acute rehabilitation facility. Conclusion: For this patient with CIDP, effective collaborative team communication and interdisciplinary management worked to optimize clinical decision making and recovery.