Chronic Inflammatory Demyelinating Polyneuropathy

By: Kyle Leato, SPTA

OBJECTIVES

• Provide background information

• Clinical Presentation

• Cause

• Treatment

• Importance to Physical Therapy

• Conclusion

Background Information• What is CIDP?

– It is a common, under diagnosed immune-mediated

inflammatory disorder of the peripheral nervous system.

(Hartung, et al., 2005)

• Commonly referred to as:

– chronic relapsing polyneuropathy

• Closely related to:

– Guillain-Barré syndrome.

• Prevalence:

– 0.5 out of 100,000 children

– 1-2 per 100,000 adults

CIDP vs. Guillain-Barré

CIDPGuillain-

Barré Syndrome

Onset Slow onset & progress for a

longer period; may return in the future

Rapid onset that progresses quickly

& stops progressing within 2-4 weeks

Treatment

Often needs sustained treatment

(even with remission)

Once symptoms stabilize there is rarely any further

deterioration

Cause• The body’s immune system attacks the nerves in

the periphery, affecting the limbs and organs of

the body(Forsberg, Press & Westblad, 2009)

Symptoms• Occurrence of symmetrical weakness in both proximal and distal muscles

that progressively increases for more than 2 months.

• Impaired sensation, burning and weakness ( generally occurring in the

feet first and they gradually ascend to involve other parts of the body). 

• Absent or diminished tendon reflexes.

• Elevated CSF protein level.

• Signs of demyelination (in nerve biopsy specimens).

• Foot drop.

• When organs become involved: inability to adequately empty the bladder,

nausea, vomiting, abdominal fullness or bloating, diarrhea, or

constipation, low blood with dizziness, or trouble maintaining an erection. 

****The severity and the combination of symptoms vary for each patient. 

Treatment

• Early Stages:

– Typically PROM and positioning is used.

– Family Education

• Middle Stages:

– Tactile re-training (brushing, vibration and tapping)

– Light resistive exercises

– PNF if the patient is capable

• Late Stages:

– Transfer Training

– Gait Training with the use of an AD

– Progressive Resistive Exercises

Other Treatment Ideas• Land Based Exercising:

– Alter G Treadmill for reduced body weight

walking. Increased weight bearing over a

period of time is shown to increase

strength and the ability to ambulate

independently. (Greenwood & Tuckey,

2004)

• Water Based Exercise:

– Hydro Physio Underwater Treadmill can be

altered by increasing or decreasing the

amount of water in the tank.

– Aquatic therapy has shown to be very

beneficial to one of our own patients.

Youtube Video

https://www.youtube.com/watch?

v=6Y1glEYQAJs

Importance in Relation to Physical Therapy

• What can we as a physical therapy team do?

– Be prepared to treat the patient on a day-to-day basis

because every day can be a day of progression and/or

setbacks. Be ready for anything.

– Interdisciplinary communication between medical team,

occupational therapy and speech therapy.

– We can provide education for the patients and their support

systems.

– Maintain a positive attitude and optimistic outlook.

– MOVEMENT IS THE BEST MEDICINE!

Conclusion• It’s important to know that CIDP is a unique diagnosis to

each and every patient. (Barohn, et al., 2010)

• No treatment will be the same, therefore it is important

to be aware of their past history, their past and current

symptoms, as well as their current lifestyle.

• There is no specific “cure” that physical therapy can

provide, so we make it a goal to use the techniques,

exercises and knowledge that we have in order to best

improve the quality of the life of the patient.

References

• Barohn, et al. Chronic Inflammatory Demylinating Polyneuropathy Disease Activity

Status: Recommendations for Clinical Research Standards and Use In Clinical Practice.

Journal of the Peripheral Nervous System. 2010; 15(4): 326-333.

• Forsberg A, Press R, Westblad ME. Disability and health status in patients with chronic

infammatory demyelinating polyneuropathy. Disability & Rehabilitation. 2009; 31(9):

720-725.

• Greenwood R , Tuckey J. Rehabilitation after severe Guillain-Barré syndrome: the use of

partial body weight support. Physiotherapy Research International. 2004; 9(2): 96-103.

• Hartung H, Jander S, Kieseier BC, Köller H. Chronic inflammatory demyelinating

polyneuropathy. N Engl J Med. 2005; 352: 1343-1356.