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 combination of the deficits from Acute Inflammatory Demyelinating Polyneuropathy and Acute Disseminated Encephalomyelitis. The unique medical, physical, psychosocial and functional challenges this disorder presents to the rehabilitation team have not been described. A-70-year old individual with a 3-week course of ascending paralysis, dysesthesias, urinary retention, insomnia and cognitive deficits is presented. An individualized program of rehabilitation entailing principles of spinal cord injury, brain injury and geriatric rehabilitation was implemented. Significant improvements in upper extremity weakness, pain, bladder control, sleep disturbance and cognition were achieved, however, lower extremity weakness and truncal control deficits remained after a 10-week rehabilitation program. This case report describes the rehabilitative management of an adult with Acute Severe Combined Demyelination, highlighting the unique aspects of intervention.