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Stagnating the Symptomatic Progression of Primary Lateral Sclerosis

Journal: The AAO Journal Date: 2024/06, 34(2):Pages: 20. doi: Subito , type of study: case report

Full text    (https://meridian.allenpress.com/aaoj/article/34/2/16/500954/LBORC-NUFA-Poster-Abstracts-2024-Students)

Keywords:

case report [708]
male [767]
neuromuscular diseases [1]
OMT [3751]
osteopathic manipulative treatment [3771]
primary lateral sclerosis [1]

Abstract:

Introduction/Background: Primary lateral sclerosis (PLS) is a motor neuron disease characterized by the degeneration of corticospinal neurons. It occurs in <50,000 people in the United States, but has many similar symptoms to other neurological diseases. These symptoms include limb weakness, stiffness and spasticity, along with decreased airway bulbar muscle strength. There is no cure for PLS. Case: A 61-year-old male with a 10-year history of PLS presented to the Osteopathic Manipulative Treatment (OMT) clinic with muscle stiffness. On physical exam, the patient exhibited hyperreflexia on upper (3+) and lower (4+) extremities, and decreased range of motion (ROM) of bilateral hips (R>L). He had hoarse, slow speech and ambulated via a walker. On osteopathic exam, the patient exhibited hypertonic lower extremity muscles, bilateral diaphragm restriction and left inhaled ribs 6-8. Results: The patient had 9 visits spanning 6 months. The 2 main goals of OMT were (1) decreasing lower extremity hip restriction and (2) increasing diaphragmatic excursion. Decreasing hip restriction was accomplished via Spencer’s articulatory technique, direct myofascial release, and muscle energy. Improvement was measured via ROM flexion measurements (15° to 45° improvement) and the Ashworth scale of muscle tone (3 to 2 improvement). Diaphragmatic excursion was increased via doming the diaphragm, which allowed for compensation for his weakened bulbar muscles. Improvements were assessed through a visual decrease in accessory muscle usage and increased ability to abdominally breathe. Discussion: While PLS is a devastating disease, this case exhibited symptom improvement with OMT. One limitation is basing outcomes on a single patient; however, due to this case’s positive results and because PLS has such similar symptomatology to other neuromuscular diseases, further research into OMT’s impact is warranted.


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