A 24-year-old female suffered a complete (AIS A) spinal cord injury (SCI) at the neurological level of C7 as a result of a motor vehicle accident (MVA). The patient was determined to be medically stable 2 weeks after her accident and was transferred to an inpatient rehabilitation facility where she has been evaluated by the rehabilitation team. She currently requires total assistance for bed mobility, transfers, bowel and bladder management, wheelchair propulsion, and pressure relief. She and her husband have many questions related to expectations for her recovery, the amount of assistance she will need, as well as the type of equipment and home modifications that will be necessary. She is eager to work with physical therapy to increase her tolerance to sitting upright, improve her bed mobility, initiate transfer training, and learn to propel a wheelchair.
What is her rehabilitation prognosis?
Identify her functional limitations and assets.
What are possible complications interfering with physical therapy?
Identify appropriate outcome measures to assess functional mobility in individuals with spinal cord injury.
Describe appropriate functional goals and a plan of care specific to a patient's neurologic level and completeness of spinal cord injury within the inpatient rehabilitation setting.
Describe adaptive equipment that may be required based on an individual's level and completeness of injury.
PT considerations in the inpatient rehabilitation setting for 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 sitting tolerance and balance
- Physical therapy tests and measures: Assessment of range of motion (ROM) and strength; reliable and valid tools for functional mobility, balance, and participation restrictions
- Precautions during physical therapy: Orthostatic hypotension, autonomic dysreflexia, deep vein thrombosis, spinal instability, skin breakdown
- Complications interfering with physical therapy: Pain, spasticity, orthostatic hypotension, autonomic dysreflexia, spinal precautions, ROM restrictions, bowel and bladder management
See Case 14 for understanding spinal cord injury.
Individuals with SCI are treated in a broad spectrum of facilities, including acute hospitals, inpatient rehabilitation centers, skilled nursing facilities, outpatient day programs, outpatient clinics, and within individuals' homes. Physical therapy management includes teaching the individual functional mobility skills, self-care activities, and prevention of secondary complications. Typically, patients spend 1 to 2 weeks in the acute hospital after a traumatic SCI. This patient has just been transferred to an inpatient rehabilitation hospital (sometimes referred to as “acute rehab” or “inpatient rehab”) after spending 2 weeks in the acute hospital. An inpatient rehabilitation program consists of coordinated medical and rehabilitation services provided 24 h/d, which encourages active patient and caregiver participation. Each individual's rehabilitation program is designed in collaboration with interprofessional team members to achieve predicted outcomes and discharge to the ...