Use of Robotic Gait Training in Hyperglycaemia-Induced Central Pontine Myelinolysis: A Case Report
Objectives: To describe a rarely-seen cause of central pontine myelinolysis (CPM), and the benefits of application of robot-assisted gait retraining (RAGT) in a model of impairment-directed rehabilitation in the management of gait ataxia.
Study design: Case report.
Setting: Inpatient rehabilitation unit of tertiary hospital, Singapore.
Subjects: A 69-year-old male who presented with giddiness, cognitive impairment, and gait ataxia.
Methods: The patient underwent magnetic resonance imaging of the brain which revealed pontine hyper-intensity suggestive of CPM. His diagnostic work-up revealed significant hyperglycaemia.
Results: He underwent treatment for his metabolic derangements and was referred for rehabilitation. We added robot-assisted gait training in the treatment of his ataxia. He was able to ambulate independently subsequently and was discharged uneventfully.
Conclusion: CPM is an uncommon but disabling condition typically seen in rapid correction of hyponatraemia. In our patient this was caused by hyperglycaemia, which likely drives the same osmotic derangements that leads to the dramatic impairments that characterise this condition. Rehabilitation of hyperglycaemia-induced CPM has yet to be described but the condition is becoming more frequently recognised in clinical practice. In addition, given the benefits of RAGT in gait ataxia, there is great potential in the role that RAGT can play in the exploration of best practices beyond CPM in a model of impairment-directed therapy in future.
Keywords: myelinolysis, central pontine, robotics, gait disorders, rehabilitation
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