Event Title

Systematic Interventions encouraging a return to functional ambulation post Spinal Cord Injury: A Case Study

Location

Hall of Governors

Start Date

7-4-2017 4:00 PM

End Date

7-4-2017 6:00 PM

Description

Spinal Cord injury (SCI) is estimated to affect 11,000 Americans per year. SCI can have radical effects on the bodies sensory, motor, and autonomic systems possibly leading to further functional disability. One of the most popular goals of individuals having incurred a SCI is return of community functional ambulation. There is a limited amount of evidence present on the systematic progression of interventions to encourage a return of ambulation after an incurred spinal cord injury. This case study aims to describe and discuss a deliberate systematic progression of interventions and the patient outcomes experienced upon discharge from inpatient rehabilitation.

Subject Description: The patient is an 18 year old female diagnosed with an AIS D T1O Spinal cord injury secondary to a sustained gunshot wound. She underwent a 16 day stay at an inpatient rehabilitation clinic. At physical therapy initial evaluation, patient presented with bilateral lower extremity weakness, sensory loss, decreased proprioception, and high fall risk due to poor dynamic and static balance.

Outcome: Patient experienced increased strength, balance, sensation, and proprioception in bilateral lower extremities. Her Berg Balance Scale score increased from 39/56 to 52/56. Exceeding the MCID this changes her fall risk consideration from high to low. Patient was able to achieve all established goals and was deemed safe for discharge home without an assistive device. Patient was referred to outpatient physical therapy for continue progression of functional independence and strengthening to increase participation and aid in community reintegration.

Discussion: The patient experience a successful rehabilitation stay attaining all of her personal and all long and short term goals. Functionally she was demonstrated ability to ambulate at a moderate independent level and was deemed safe to return home without the need of assistance from another individual or an assistive device. From initial evaluation to discharge this patient progressed. There is an abundance of evidence supporting and refuting predictors of an individual's return to functional ambulation post SCI. Using multifactorial evaluative tools and clinical reasoning this patient was deemed appropriate for gait training. The interventions utilized at the beginning of the process utilized increased restrictions, increased levels of assistance, increased environmental controls. Progression of all activities involved decreased the level of control at a methodical and controlled pace. Not only was this advantageous from a mechanical point of view, it also gave the patient a sense of self-esteem and self-efficacy. These two personal factors have been correlated with increased outcomes and participation upon discharge and long term. Biomechanically, a focus was placed on decreasing/limiting compensatory patterns and encouraging typical movements before progressing intervention difficulty.

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Apr 7th, 4:00 PM Apr 7th, 6:00 PM

Systematic Interventions encouraging a return to functional ambulation post Spinal Cord Injury: A Case Study

Hall of Governors

Spinal Cord injury (SCI) is estimated to affect 11,000 Americans per year. SCI can have radical effects on the bodies sensory, motor, and autonomic systems possibly leading to further functional disability. One of the most popular goals of individuals having incurred a SCI is return of community functional ambulation. There is a limited amount of evidence present on the systematic progression of interventions to encourage a return of ambulation after an incurred spinal cord injury. This case study aims to describe and discuss a deliberate systematic progression of interventions and the patient outcomes experienced upon discharge from inpatient rehabilitation.

Subject Description: The patient is an 18 year old female diagnosed with an AIS D T1O Spinal cord injury secondary to a sustained gunshot wound. She underwent a 16 day stay at an inpatient rehabilitation clinic. At physical therapy initial evaluation, patient presented with bilateral lower extremity weakness, sensory loss, decreased proprioception, and high fall risk due to poor dynamic and static balance.

Outcome: Patient experienced increased strength, balance, sensation, and proprioception in bilateral lower extremities. Her Berg Balance Scale score increased from 39/56 to 52/56. Exceeding the MCID this changes her fall risk consideration from high to low. Patient was able to achieve all established goals and was deemed safe for discharge home without an assistive device. Patient was referred to outpatient physical therapy for continue progression of functional independence and strengthening to increase participation and aid in community reintegration.

Discussion: The patient experience a successful rehabilitation stay attaining all of her personal and all long and short term goals. Functionally she was demonstrated ability to ambulate at a moderate independent level and was deemed safe to return home without the need of assistance from another individual or an assistive device. From initial evaluation to discharge this patient progressed. There is an abundance of evidence supporting and refuting predictors of an individual's return to functional ambulation post SCI. Using multifactorial evaluative tools and clinical reasoning this patient was deemed appropriate for gait training. The interventions utilized at the beginning of the process utilized increased restrictions, increased levels of assistance, increased environmental controls. Progression of all activities involved decreased the level of control at a methodical and controlled pace. Not only was this advantageous from a mechanical point of view, it also gave the patient a sense of self-esteem and self-efficacy. These two personal factors have been correlated with increased outcomes and participation upon discharge and long term. Biomechanically, a focus was placed on decreasing/limiting compensatory patterns and encouraging typical movements before progressing intervention difficulty.