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首页> 外文期刊>The Internet journal of allied health sciences practice >A Community-dwelling Older Adult with Concurrent Human Immunodeficiency Virus, Type 1 Diabetes Mellitus and Peripheral Neuropathy: A Case Report.
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A Community-dwelling Older Adult with Concurrent Human Immunodeficiency Virus, Type 1 Diabetes Mellitus and Peripheral Neuropathy: A Case Report.

机译：并发人类免疫缺陷病毒，1型糖尿病和周围神经病变的社区居民老年人：1例病例报告。

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Background: Peripheral neuropathy (PN) may be idiopathic, iatrogenic, or be caused by any number of chronic diseases such as human immunodeficiency virus (HIV) and type 1 diabetes mellitus (DM1). PN is of particular interest to physical therapists, because it contributes to an individual’s risk of falling. Purpose: (1) To describe a community-dwelling older adult with HIV, DM1, PN, and neurotoxic medication use (2) Highlight the pathophysiology of each diagnoses and resulting neuropathy and describe their effect on clinical decision-making when they are both present. Case Description: A seventy-two year-old man presented to outpatient physical therapy with PN and concurrent HIV and DM1. Physical examination identified decreased somatosensation and proprioception amongst other findings. Based on Functional Reach Test (FRT) and the Activities-Specific Balance Confidence Scale (ABC) fall risk cutoff scores, he was at risk of falling. Due to his PN, he was hindered in his ability to maintain balance in low-light situations, traverse stairs with objects in hand, and navigate crowded spaces while traveling and taking photographs. Intervention included balance-challenging neuromotor exercises, progressing in difficulty, and including static, dynamic, anticipatory, and reactive balance interventions. Outcomes: Despite chronic health conditions, the patient experienced meaningful improvements in balance ability and balance confidence. Over 5 sessions of physical therapy in 7 weeks, he improved his scores and was no longer a fall risk on the FRT and ABC. Discussion: PN may be the result of a single diagnosis, or multiple concurrent diagnoses. Studies are much more likely to include individuals with PN from a single source, as opposed to multiple concurrent diagnoses. In the presence of multiple etiologies, it is difficult to determine the best physical therapy intervention approach. Areas for future research may take two directions: (1) Including patients with coexisting conditions in trials (2) Stratification with very clear description of diagnoses in studies seeking optimal examination and intervention approaches. Conclusion: In the absence of clearer guidelines and stratification, an understanding of pathophysiology, patient goals and expectations, and preliminary published evidence should be used to develop an individualized approach to evaluating and treating individuals with PN.
机译：背景：周围神经病变（PN）可能是特发性的，医源性的，或由许多慢性疾病引起的，例如人类免疫缺陷病毒（HIV）和1型糖尿病（DM1）。 PN对于物理治疗师特别感兴趣，因为它会增加个人跌倒的风险。目的：（1）描述患有HIV，DM1，PN和神经毒性药物的社区居民老年人（2）突出显示每种诊断的病理生理学和所引起的神经病变，并描述它们均对临床决策的影响。病例描述：一名七十二岁的男子接受了PN和并发HIV和DM1的门诊物理治疗。体格检查发现躯体感觉和本体感受的降低以及其他发现。根据功能触及测验（FRT）和特定于活动的平衡信心量表（ABC）的跌倒风险截止评分，他处于跌倒的风险中。由于他的PN，他在弱光条件下保持平衡，手持物体穿越楼梯，在旅行和拍照时在拥挤的空间中导航的能力受到了阻碍。干预措施包括挑战性平衡的神经运动练习，困难程度的进展，包括静态，动态，预期和反应性平衡干预。结果：尽管患有慢性病，但患者的平衡能力和平衡信心得到了有意义的改善。在7周内进行了5次以上的物理治疗，他的得分得到了提高，并且不再因FRT和ABC而跌倒。讨论：PN可能是一次诊断或多次并发诊断的结果。与多个并发诊断相反，研究更有可能包括来自单一来源的PN个体。在多种病因的情况下，很难确定最佳的物理疗法干预方法。未来的研究领域可能有两个方向：（1）在试验中纳入有并存病的患者（2）在寻求最佳检查和干预方法的研究中，对诊断的描述非常清晰。结论：在缺乏更明确的指南和分层的情况下，应使用病理生理学，患者目标和期望以及初步发表的证据来开发个性化方法来评估和治疗PN患者。

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