Physical medicine and rehabilitation multidisciplinary approach in a case of posterior cortical atrophy

Abstract

Posterior cortical atrophy (PCA) is a degenerative syndrome heralded by progressive visual and spatial disorders, while the memory and execution capacities remain preserved for a long time. We report the clinical case of a female patient who received a global Physical and Rehabilitation Medicine (PRM) therapy. Our objective is to highlight the interest of a multidisciplinary approach in PCA. A female patient, LO, 60 years old, presented with visual and spatial difficulties of progressive worsening, while global cognitive efficiency was preserved, signing PCA, with a loss of autonomy in daily life. A six-month multidisciplinary approach (speech therapy, occupational therapy, and physiotherapy) centered on her visual disturbances and associated to the reinforcement of her preserved abilities, as well as a rehabilitation program, was proposed. At the end of this period, LO was again able to read, find efficient exploratory strategies, use the underground, visit museums, have leisure activities, and carry out everyday life activities, which she had ended up abandoning. The specific therapeutic management allowed reaching functional objectives. Our hypothesis is that the absence of other cognitive disorders allowed this type of rehabilitation "contract". The neurodegenerative pathologies responsible for specific instrumental disabilities without global cognitive alteration, and particularly PCA, should be able to benefit from a specific, or even multidisciplinary PMR therapy approach.

Posterior Cortical Atrophy: Review of the Recent Literature

“…A multidisciplinary approach combining speech therapy, occupational therapy, and physiotherapy was applied to a single PCA patient. Marked improvement of the patient's autonomy was observed after 6 months of therapy, thanks to a better understanding of PCA and to the development of compensation strategies for daily life activities (e.g., dressing, reading) [53].…”

Organische Angststörung bei posteriorer kortikaler Atrophie

“…Neben der medikamentösen, symptomatischen Behandlung liegt bei der PCA ein Schwerpunkt auf nicht medikamentösen Maßnahmen. Hierunter fallen kognitives Training und Ergotherapie [15,16], darüber hinaus unterstützende Maßnahmen zum Beispiel durch ein ambulant betreutes Wohnen, Haushaltshilfen sowie die Einleitung einer gesetzlichen Betreuung. Insbesondere davon und auch von regelmäßigen Kontakten in der psychiatrischen Institutsambulanz der Klinik mit Teilnahme am Gruppenangebot profitierte die Patientin und ein Leben in der gewohnten Umgebung ist bis anhin möglich, wobei die beschriebenen Defizite progredient sind.…”

Pronounced Impairment of Activities of Daily Living in Posterior Cortical Atrophy

“…Few studies have been undertaken to describe how a diagnosis of PCA impacts ADLs. Shakespeare et al [10] used the Cambridge Behavioural Inventory to show a loss of independence in everyday skills and self-care, and cases studies [11, 12] support this finding of a loss of autonomy. The primarily visual nature of deficits in PCA is likely to have a pronounced impact on ADLs, and, thus, a more extensive profile of impairment is needed.…”