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A 5-year-old boy was admitted to the regional trauma center through the emergency department (ED) following a motor vehicle accident 4 days ago. He was a restrained passenger in the front seat during a highway collision. His injuries are consistent with a cervical flexion injury. He was immediately placed on full spine precautions. Results from cervical spine radiographs and computed tomography (CT) scan reveal no overt vertebral abnormality. A T2-weighted magnetic resonance imaging (MRI) scan shows widespread edema in the interspinous ligaments and paraspinal muscles from C4 to T1. In the ED, his American Spinal Injury Association Impairment Scale (AIS) classification was C4, AIS B. He was immediately started on methylprednisolone and immobilized with a hard cervical collar. Three days ago, he was transferred to the pediatric intensive care unit (PICU). He was fitted for and currently immobilized in a rigid cervicothoracic brace (Guilford brace). In the PICU, his AIS classification was found to be C6, AIS C (Fig. 30-1). The following spinal precautions have been advised from the spinal orthopaedist: the patient can be out of bed, but the Guilford brace must be worn at all times. The patient's mother and younger sister were also involved in the accident. His mother sustained multiple musculoskeletal injuries including pelvic fracture and abdominal lacerations. She was also admitted to the same hospital. His sister had only minor injuries and was discharged home with their father. The physical therapist has been asked to examine the child and design a plan of care. He is expected to be discharged to a pediatric inpatient rehabilitation center in a week and a half.

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Figure 30-1.
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American Spinal Injury Association Neurological Classification of Spinal Cord Injury form for the case patient. (Reproduced with permission from American Spinal Injury Association: International Standards for Neurological Classification of Spinal Cord Injury, revised 2011; Atlanta, GA. Reprinted 2011.)

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What are the examination priorities?

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Based on his health condition, what do you anticipate may be the contributors to activity limitations?

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What is his rehabilitation prognosis?

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What are the most appropriate physical therapy interventions?

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What precautions should be taken during physical therapy examination and/or interventions?

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Identify the psychological (or psychosocial) factors apparent in this case.

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  • AMERICAN SPINAL INJURY ASSOCIATION (ASIA) CLASSIFICATION OF SPINAL CORD INJURY: Classification system used to determine an individual's neurological level of injury, create a prognosis, and predict outcomes for individuals with spinal cord injuryGUILFORD BRACE: Rigid cervicothoracic orthosis with anterior and posterior chest plates and a chin and occipital piece that are connected by shoulder straps; designed to limit flexion and ...

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