Inpatient rehabilitation and functional outcome of a case of anti-SRP immune mediated necrotising myopathy

Abstract

Objective: Immune-mediated necrotizing myopathy associated with anti-signal recognition particle antibodies is a rare and debilitating condition characterized by significant muscle weakness and resultant disability. Although there are existing recommendations for physical therapy and exercise for patients with myositis in current literature, effective rehabilitation guidelines for such patients have not been fully established.

Case report: A 42-year-old woman presented with subacute onset proximal upper and lower limb weakness and dysphagia. She was diagnosed with anti-SRP immune-mediated necrotizing myopathy and was promptly initiated on aggressive immunosuppressive therapy. Despite this, she had significant impairment in function, including the inability to ambulate.

Intervention and outcome: The patient underwent an intensive structured inpatient rehabilitation programme consisting of strength and endurance exercises combined with functional exercises and robot-assisted gait training. This resulted in major improvements in objective outcomes including Functional Independence Measure, Modified Barthel Index, 10-metre-walk test and 6-minute-walk test scores. The programme was well tolerated by the patient with no adverse events.

Conclusion: This case details the crucial role of a structured rehabilitation programme in the holistic management of a patient with anti-SRP immune-mediated necrotizing myopathy. It also highlights the use of robotics in gait training, resulting in successful functional outcomes for the patient.