Case Report

Physical Therapy for Transverse Myelitis: A Case Report

Allison Buchanan, Kelli J Wilkerson and Han-Hung Huang*

Published: 08 January, 2018 | Volume 2 - Issue 1 | Pages: 015-021

Background and Purpose: Transverse myelitis (TM) is a rare neurological diagnosis found in 1-4 per million people. Rehabilitation is recommended secondary to steroid treatment. There is limited clinical research on physical therapy (PT) for TM. The purpose of this case report is to present PT examination and management strategies for a patient with TM.

Case Description: A 25-year-old female patient diagnosed with TM was referred to PT. She presented foot drop causing ataxic gait, decreased sensation in bilateral lower extremities, significant fatigue, and low back pain. The patient required significant rest time between all tests and measures due to severely increased fatigue. PT plan of care was focused on therapeutic exercises per patient tolerance, passive range of motion (ROM) administered by the therapist, and gait training when activity tolerance was increased.

Outcomes: The patient was able to tolerate bouts of exercise as prescribed through home exercise program. She responded very well to passive ROM treatment during breaks between exercises to maintain ROM and decrease rigidity. Active ROM exercise was used to build activity tolerance while being mindful of limited ability due to fatigue. Upon increased activity tolerance, the patient was able to tolerate gait training with multiple breaks and maintain corrected gait when addressed during treatment.

Discussion: PT intervention was helpful for this patient with TM. Breaking down functional activities based on patient tolerance is important when treating people with TM. More experimental research is needed to support the benefits of PT for TM.

Read Full Article HTML DOI: 10.29328/journal.jnpr.1001017 Cite this Article Read Full Article PDF


Transverse Myelitis; Physical Therapy; Fatigue; Exercise


  1. Calis M, Kirnap M, Calis H, Mistik S, Demir H. Rehabilitation results of patients with acute transverse myelitis. Bratisl Lek Listy. 2011; 112: 154-156. Ref.: https://goo.gl/vJwZ2A
  2. Krishnan C. Research at the Johns Hopkins Transverse Myelopathy Center. Transverse Myelitis Association. 2002; 5: 6. Ref.: https://goo.gl/FMvkjq
  3. Scott TF, Frohman EM, De Seze J, Gronseth GS, Weinshenker BG, et al. Evidence-based guideline: clinical evaluation and treatment of transverse myelitis: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2011; 77: 2128-2134. Ref.: https://goo.gl/PyFsTf
  4. Absoud M, Gadian J, Hellier J, Brex PA, Ciccarelli O, et al. Protocol for a multicentre randomiSed controlled TRial of IntraVEnous immunoglobulin versus standard therapy for the treatment of transverse myelitis in adults and children (STRIVE). BMJ Open. 2015; 5: 008312. Ref.: https://goo.gl/Dz9CyM
  5. Frohman EM, Wingerchuk DM. Clinical practice. Transverse myelitis. N Engl J Med. 2010; 363: 564-572. Ref.: https://goo.gl/8ZkDi4
  6. Krishnan C, Adam Kaplin I, Deepa Deshpande M, Carlos Pardo A, Douglas Kerr A. Transverse Myelitis: pathogenesis, diagnosis and treatment. Front Biosci. 2004; 9: 1483-1499. Ref.: https://goo.gl/sRHJFQ
  7. Childs JD, Piva SR, Fritz JM. Responsiveness of the numeric pain rating scale in patients with low back pain. Spine (Phila Pa 1976). 2005; 30: 1331-1334. Ref.: https://goo.gl/kAxWTT
  8. Liang HW, Hou WH, Chang KS. Application of the modified lower extremity functional scale in low back pain. Spine (Phila Pa 1976). 2013; 38: 2043-2048. Ref.: https://goo.gl/aSdQKQ
  9. Bennett SE, Bromley LE, Fisher NM, Tomita MR, Niewczyk P. Validity and Reliability of Four Clinical Gait Measures in Patients with Multiple Sclerosis. Int J MS Care. 2017; 19: 247-252. Ref.: https://goo.gl/ZLK96X
  10. Lyders Johansen K, Derby Stistrup R, Skibdal Schjøtt C, Madsen J, Vinther A. Absolute and Relative Reliability of the Timed 'Up & Go' Test and '30second Chair-Stand' Test in Hospitalised Patients with Stroke. PLoS One. 2016; 11: 0165663. Ref.: https://goo.gl/zf61uL
  11. Vianin M. Psychometric properties and clinical usefulness of the Oswestry Disability Index. J Chiropr Med. 2008; 7: 161-163. Ref.: https://goo.gl/kBnVqv
  12. Sopher R. Why a Person with TM Should Consider Physical Therapy. Transverse Myelitis Association Newsletter. 2000; 3.
  13. Sadowsky CL, Becker Daniel, Bosques Glendaliz, Dean Janet M, McDonald John W, et al., Rehabilitation in transverse myelitis. Continuum (Minneap Minn). 2011; 17: 816-830. Ref.: https://goo.gl/DfJjdT
  14. Narang S, Ganvir S. Efficacy of Kaltenbohn Mobilization on Patients with Osteoarthritis of Knee Joint. Indian Journal of Physiotherapy & Occupational Therapy. 2014; 8: 162-169. Ref.: https://goo.gl/EH619P
  15. Mohanty S, Shrestha RL. Effect of Electroacupuncture Rehabilitation in Transverse Myelitis: A Case Report. J Acupunct Meridian Stud. 2017; 10: 286-289. Ref.: https://goo.gl/JtUzrS
  16. Seok JM, Choi M, Cho EB, Lee HL, Kim BJ, et al. Fatigue in patients with neuromyelitis optica spectrum disorder and its impact on quality of life. PLoS One. 2017; 12: 0177230. Ref.: https://goo.gl/9XczLX

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