New England Rehabilitation Hospital, 2 Rehabilitation Way, Woburn, MA 01801, USA.
Phys Ther. 2011 Sep;91(9):1412-23. doi: 10.2522/ptj.20110020. Epub 2011 Jul 7.
Lyme disease is well documented in the literature; however, specific physical therapy interventions for the pediatric population with residual effects of Lyme disease have not been addressed. The purposes of this retrospective case report are: (1) to present an example of a therapeutic intervention for a pediatric patient in the late stages of Lyme disease with related musculoskeletal dysfunction and severely impaired quality of life, (2) to report the patient's functional outcomes from treatment, and (3) to discuss implications for treatment of patients with musculoskeletal dysfunction in the late stages of Lyme disease.
The patient was a 14-year old girl who had contracted Lyme disease 1 year prior to initiation of physical therapy. She was unable to participate with her peers in school, church, and sporting events due to significant impairments in strength (force-generating capacity), endurance, and gait; fatigue; pain; and total body tremor. Therapeutic exercise and gait training were used for treatment. The patient actively participated in managing her care by providing feedback during interventions and setting goals.
After 18 weeks of treatment, the patient achieved 96.7% of her predicted distance on the Six-Minute Walk Test with normal gait mechanics and returned to playing high school sports. She had a manual muscle test grade of 4/5 or greater in major extremity muscle groups. She returned to school and church participation with minimal total body tremor when fatigued and daily pain rated 0 to 3/10.
Therapeutic exercise and gait training may facilitate return to function in an adolescent patient with late effects of Lyme disease. Further investigation is advised to establish treatment effects in a broader population.
莱姆病在文献中有详细记载；然而，针对莱姆病后遗症的儿科患者，尚未提出具体的物理治疗干预措施。本回顾性病例报告的目的是：（1）介绍一例莱姆病晚期伴相关肌肉骨骼功能障碍和生活质量严重受损的儿科患者的治疗干预措施，（2）报告患者的治疗效果，（3）讨论莱姆病晚期肌肉骨骼功能障碍患者治疗的意义。
患者为 14 岁女孩，在开始物理治疗前 1 年感染莱姆病。由于力量（产生力量的能力）、耐力和步态严重受损、疲劳、疼痛和全身震颤，她无法像同龄人一样参加学校、教堂和体育活动。治疗采用运动锻炼和步态训练。患者积极参与管理自己的治疗，在干预过程中提供反馈并设定目标。
治疗 18 周后，患者在六分钟步行测试中达到预测距离的 96.7%，步态力学正常，并恢复高中体育活动。她主要肢体肌群的徒手肌力测试等级为 4/5 或更高。她回到学校和教堂，当疲劳时全身震颤最小，日常疼痛评分为 0 到 3/10。
运动锻炼和步态训练可能有助于莱姆病后遗症青少年患者恢复功能。建议进一步研究以确定更广泛人群的治疗效果。
