Table 1 Description of case studies

From: Full-body physical therapy evaluation for pre- and post-hematopoietic cell transplant patients and the need for a modified rehabilitation musculoskeletal specific grading system for chronic graft-versus-host disease

Case presentation

cGVHD full-body assessment

Case A:

 

A 14-year-old female, recipient of allogeneic HCT in 2015 for sickle cell disease. Developed severe GVHD of the skin and the mouth after taper of cyclosporine. GVHD intensity fluctuated with treatments, and with each flare, she required a course of high dose corticosteroids. In early May 2017, the patient presented with a severe bout of oral cGVHD with ulceration resulting in difficulties in eating and complain about not being able to open the mouth. The 2014 National Institutes of Health (NIH) Consensus Criteria score for chronic GVHD was 8 (on systemic treatments) when the referral to PT for ankle GVHD took place

Wide spread skin GVHD, depigmentation over the arms, legs, and all over the body. Video gait analysis—suspected hip involvement by studying the gait. Upper limb: significant weakness in bilateral grip strength and pinch bilateral revealed on JAMAR. Lower limb: significant bilateral reduced supine SLR indicating hamstring tightness. Single leg balance with right leg—not able. The right ankle dorsiflexion 30, plantar flexion 25 and the left ankle dorsiflexion 20 and the plantar flexion 20

Case B:

 

A 23-year-old male with myelodysplastic syndrome and underwent allogeneic stem cell transplantation in 2016. Developed severe chronic graft-versus-host disease of the liver, lungs, and MSK system. Reported pain and swelling in the wrist. He had been on steroids for many months, which had unfortunately led to avascular necrosis of both hips causing severe sharp pain, and currently, he is opioid-dependent. The 2014 cGVHD NIH score was recorded as 3 in 2016, but in 2017 it progressed to 8

The tight appearance of bilateral forearm muscles more on the volar aspect. AROM left wrist extension 12° with fingers straight and 55° with fingers closed; Rt supination—30, left side—70 wrist extension 10° with fingers straight and 60° with fingers closed. Wrist to wall Rt 25 cm and left 25 cm, elbow to wall Rt 8 cm and left 8 cm, straight leg raise test—bed to heel left 26 cm and Rt 28 cm pinch test—Rt 4 kg and left 3 kg, JAMAR grip test—Rt 15 kg and left 12, full range of motion in the hip with end-range tightness. Not able to sit in prayer position

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