Objective: To evaluate the benefit of physiotherapy (PT) interventions on functional limitations in a patient with Lance-Adams Syndrome (LAS) with post-hypoxic myoclonus using 10 meter walk test (10MWT).

Background: LAS is diagnosed if patients have post-hypoxic myoclonus following successful cardiopulmonary resuscitation (1). Here we present the case of a 25 y.o. F with bipolar disorder who suffered myoclonus from hypoxic brain damage after hanging herself. Clinical features: myoclonus, opisthotonos, asymmetric tonic neck reflex, left ankle inversion/plantarflexion tone, visual deficits, multiple falls, poor endurance and severe anxiety. 1. Lance JW, Adams RD. The syndrome of intention or action myoclonus as a sequel to hypoxic encephalopathy. Brain. 1963;86:111-136.

Methods: Myoclonus: deep breathing, approximation strategies. Neuromuscular re-education: postural control, weight shifting. Gait training: with body-weight support (BWS) hand-held assistance (HHA) weighted vest and ankle weights. Bed mobility and transfer training (wc-mat, wc-floor, sit-stand). 2×10 visits/week x 60 min. DME: Rifton Pacer walker and transport wc. HEP: gait with HHA and Rifton Pacer walker x1 hour/day. Selected outcome measure:10MWT.

Results: Myoclonus: well-managed with deep breathing/approximation. Frequent breaks provided to prevent fatigue-induced myoclonic exacerbation. Falls: 1 from visit 1-10, 0 since visit 10. Functional mobility: clinically meaningful improvement achieved in gait velocity per 10MWT at visit 10 and 18, classifying pt as safe for household ambulation. I with crawling, mod I with gait using Rifton walker, min HHA with verbals cues to decrease step length for optimal control, community distances in transport wc. I bed mobility, min A stand-step transfer technique to wc and car when pt wore neon shoelaces and steps to neon floor stripes to improve use of limited vision. Strength/ROM remained WFL. Fair – postural control during myoclonic episodes.

Conclusions: Our data suggests PT interventions for functional mobility are beneficial in patient with LAS with post-hypoxic myoclonus. 10MWT is sensitive to changes in this patient population and is a recommended outcome measure. Motivation and compliance with gait program as part of HEP is critical in optimizing rehabilitative outcomes. Given the rarity of LAS a case study format is the most appropriate for dissemination of information and rehabilitation guidelines at this time.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/lance-adams-syndrome-with-post-hypoxic-myoclonus-physiotherapy-intervention/