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Physical and Edema Therapy Management of Amyloidosis in the Acute Care Setting

A Case Report

Boudreau, Jennifer, PT, DPT, NCS1; Lagunilla, Jane, PT, CLT-LANA, WCC2; Kotkiewicz, Jean, PT, DPT, CLT, WCC, CKTP3

doi: 10.1097/01.REO.0000000000000129
CASE REPORT: PDF Only

Background and Purpose: Currently, there are no formal guidelines describing rehabilitation interventions for those with amyloidosis. This case report explores the application of physical and edema therapy interventions, including external compression, for a patient with a diagnosis of light-chain (AL) amyloidosis and functionally limiting orthostatic hypotension in the acute care setting.

Case Description: A 52-year-old man with a diagnosis of immunoglobulin AL amyloidosis presented to the acute care setting with progressed orthostatic hypotension, bilateral lower extremity edema, and episodes of syncope. The patient spent 17 days in the inpatient setting and received physical therapy (PT) and edema therapy through the inpatient lymphedema service. Rehabilitation focused on exercise, compression, and behavioral and educational interventions over the course of 9 PT sessions and 7 edema therapy sessions.

Outcomes: Before interventions, the patient was unable to safely ambulate at home due to syncope. He progressed to being able to ambulate 1560 ft with seated rests. The patient demonstrated decreased limb circumferential measurements, improved performance on the 6-Minute Walk Test, improved ability to self-manage orthostatic hypotension and edema, and increased participation in activities of daily living.

Discussion: The combination of physical and edema therapy services may have compensated for orthostatic hypotension and improved standing tolerance. The patient's blood urea nitrogen and brain natriuretic peptide levels may have improved because of the application of external compression. Overall, the patient experienced decreased limb size, increased exercise tolerance, decreased syncopal episodes, and improved quality of life without changes in pharmacologic management or adverse events.

1PT Neurology Clinical Specialist, treating physical therapist, Memorial Sloan Kettering Cancer Center, New York, NY

2Lymphedema Clinical Specialist, treating lymphedema therapist, Memorial Sloan Kettering Cancer Center, New York, NY

3PT Supervisor, Memorial Sloan Kettering Cancer Center, New York, NY

Correspondence: Jean Kotkiewicz, PT, DPT, CLT, WCC, CKTP, Memorial Sloan Kettering Cancer Center, 1275 York Ave, H-110, New York, NY 10065 (kotkiewj@mskcc.org).

The authors declare no conflicts of interest.

Copyright 2018 © Oncology Section, APTA
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