Rehabilitation Program
Physical Therapy
Comprehensive physical therapy for patients with alcoholic neuropathy may include the following:
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Gait and balance training, possibly with an assistive device for safety
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Range of motion (ROM) exercises and stretching, particularly for the gastrocnemius-soleus muscle, to prevent contracture and maintain normal gait mechanics
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Strength training of weakened muscles
Occupational Therapy
Occupational therapy also can be an important component of the rehabilitation process in individuals with alcoholic neuropathy. Various elements can be combined into a program to help the patient maximize function, including the following:
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Training in performance of activities of daily living (ADL), with adaptive equipment if necessary
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Compensatory strategies to accommodate for insensate or weakened limbs
Medical Issues/Complications
Home evaluations can be ordered to assess the safety, appropriateness, and functionality of the patient in the home.
Surgical Intervention
If liver damage is evident, appropriate consultation with a transplantation service is recommended. However, neuropathy is generally an exclusion criterion for transplantation.
Interestingly, there has been a case of liver transplantation resulting in resolution of alcoholic polyneuropathy, although the patient was also treated for nutritional and vitamin-deficiency polyneuropathy. [29]
Consultations
Consultation with a psychiatrist may be indicated to help patients with chronic alcoholism recover from the physical and emotional withdrawal associated with cessation of alcohol consumption.
Consultation with a nutritionist may be indicated to help formulate strategies for replacement of essential nutrients in malnourished alcoholic patients.
Referral to a substance abuse support group, such as Alcoholics Anonymous (AA), may help patients to cope with alcohol cessation.
Other Treatment
An ankle-foot orthosis (AFO) may be needed to assist patients with weak ankle dorsiflexion, eversion, and/or plantar flexion. This device also can help with ankle proprioception and can improve gait and prevent ankle sprains. Vigilant foot care and the use of shoes with an enlarged toe box are useful in preventing foot ulcers.
The use of warm or hot footbaths is a potential hazard in alcoholic neuropathy, because such treatment may cause burns to a patient with an insensate extremity.
