A 24-year-old female suffered a complete (AIS A) spinal cord injury at the neurological level of C7 as a result of a motor vehicle accident (MVA). She is an elementary school teacher and lives with her husband in a single story home. Prior to her injury, she enjoyed 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 patient has just been discharged from an inpatient rehabilitation facility (Case 15). During her 6-week inpatient rehabilitation, she demonstrated the ability to tolerate upright sitting for over 5 hours and she no longer requires the use of an abdominal binder or lower extremity compression devices to prevent orthostatic hypotension. She had begun training in wheelchair propulsion, sitting balance, and transfers. She now presents to an outpatient physical therapy clinic and the physical therapist must help her develop appropriate goals for the next 6 months.
What is her rehabilitation prognosis?
Identify her functional limitations and assets.
What are possible complications interfering with physical therapy?
Identify the differences between compensatory and restorative approaches to rehabilitation.
List appropriate long-term (6-month) goals for the individual with a complete SCI at the neurological level of C7.
Describe appropriate physical therapy interventions in an outpatient setting for an individual with SCI.
Identify range of motion requirements for individuals with SCI and the need for selective stretching.
Describe methods of preventing upper extremity overuse injuries and pain for individuals with SCI.
PT considerations during management of the individual with loss of muscle activation, loss of 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, sitting balance, transfers, and wheelchair propulsion
- Physical therapy tests and measures: Assessment of range of motion (ROM) and strength; reliable and valid tools for functional mobility, balance, gait, 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 for an individual with SCI includes teaching functional mobility skills, self-care activities, and prevention of secondary complications. The physical therapist often works as part of a medical team including primary care physicians, neurologists, nurses, occupational therapists, speech therapists, mental health professionals, assistive technology professionals, and other allied health professionals. In addition, an individual with SCI will have many questions related to sexuality, sexual functioning, and fertility. The ...