The impact of resistance training on balance and functional ability of a patient with multiple system atrophy.

PURPOSE: This case study documents the impact of a resistance-training program on a female patient with Multiple System Atrophy (MSA). CASE DESCRIPTION: A 68-year-old female with a 2-year history of MSA was referred to physical therapy with a history of falls, increasing loss of balance and rapidly progressing lower body Parkinson's like dysfunction. Examination included range of motion, muscle strength, motor control, ambulation with and without assistive device, and determination of postural hypotension. Functional Reach (FR), Timed Up and Go (TUG), timed single limb stance (SLS), and the Performance Oriented Mobility Assessment (POMA) assessed safety, balance, and fall risk. Hypokinesia and festinating gait were observed during ambulation. Transfers sit to stand were functional, but with compromised safety. Impairments of muscle performance were found at ankle, knee, and hip. The patient wanted to be able to live at home to care for herself and disabled spouse. Low to moderate intensity, lower extremity resistance training was added (twice weekly) to an existing program of balance and flexibility exercises. OUTCOMES: Clinically meaningful gains were achieved in all functional measures, and the patient performed SLS for 10 seconds when previously unable. More importantly, she achieved her goal of remaining at home with her spouse. DISCUSSION: The addition of resistance training to an existing program of balance and flexibility exercises did not cause any adverse effects and appears to have led to improvements in balance and functional ability.