One week ago, a 24-year-old female suffered a complete spinal cord injury at the neurological level of C7 as a result of a motor vehicle accident (MVA). Surgical interventions immediately following the MVA included a laminectomy and fusion of the C6 to T1 vertebral levels. Four days after surgery, she developed a deep vein thrombosis in her calf and had an inferior vena cava filter placed to prevent pulmonary embolism. She is currently in the intensive care unit (ICU). Her impairments include paralysis and sensory loss in bilateral lower extremities, trunk, and upper extremities. Spinal shock is resolving and she now presents with lower extremity spasticity, hyperreflexia, reflexive bowel and bladder, and difficulty clearing secretions from her lungs. She is an elementary school teacher and lives with her husband in a single story home. She enjoys playing basketball, surfing, and playing with her dogs. She does not have children, but she and her husband planned on starting a family in a few years. The physical therapist is asked to evaluate and treat the patient in the ICU.
What are possible complications interfering with physical therapy?
What are the most appropriate physical therapy outcome measures?
What are the examination priorities?
What precautions should be taken during physical therapy examination?
Based on her health condition, what do you anticipate will be the contributors to activity limitations?
- DEEP VEIN THROMBOSIS (DVT): Partial or complete occlusion of a deep vein by a thrombus (clot) usually caused by venous stasis, hypercoagulability, and/or injury to the wall of the vein
- INFERIOR VENA CAVA FILTER: Vascular filter placed in the inferior vena cava to prevent pulmonary embolism
- PULMONARY EMBOLISM: Blood clot that becomes lodged in a pulmonary artery and obstructs blood supply to the lung, and can result in death; most common cause is a DVT that has become dislodged
- SPINAL SHOCK: Flaccid muscle paralysis and absence of reflexes below the level of a spinal cord injury; can last for hours to weeks
Describe the etiology, incidence, and prevalence of spinal cord injuries.
Use the American Spinal Injury Association (ASIA) classification guidelines of spinal cord injury to determine motor levels, sensory levels, a single neurologic level, and the zone of partial preservation, if appropriate.
Describe clinical syndromes related to incomplete spinal cord injuries.
Describe primary and secondary impairments common in individuals with spinal cord injuries.
Describe the physical therapy evaluation and potential need for referral to other healthcare professionals for individuals with spinal cord injury.
PT considerations during management of the individual with loss of muscle activation and sensation, decreased functional mobility, and multiple medical complications due to spinal cord injury:
- General physical therapy plan of care/goals: Improve functional mobility including bed mobility, transfers, and locomotion (wheelchair propulsion); improve ...