A 50-year-old male presented to the emergency department (ED) after worsening back pain and progressively decreasing strength in his legs. The patient had presented 6 months prior to an overseas ED and had a brief hospitalization after complaining of back pain and right leg radiculopathy. Imaging conducted during that admission found “nine bulging discs,” but aside from this brief hospitalization, no interventions were undertaken for his back pain. The patient's prior medical history consists of chronic back pain that the patient attributes to his work in the military. Additional medical history includes hypertension, obesity (body mass index = 32.4 kg/m2), left ventricular hypertrophy, and recurrent kidney stones. He has had a long military career and he was working in security prior to his current presentation at the ED. He has an active lifestyle with regular motorcycle riding, swimming, skydiving, and other activities that give him an “adrenaline rush.” The patient was urgently admitted to the hospital and he received an emergency decompression laminectomy from T11 to L4 with hardware placement. Immediately postoperatively, the patient was unable to move his lower extremities. The postoperative computed tomography (CT) scan showed large disc herniations from T6 to T10, so a second surgery for transpedicular decompression from T9 to T10 was conducted. Two days after admission, the patient had his third and final surgery to place pedicular screws from T6 to L4. The patient spent 3 weeks in the acute hospital with minimal mobility or physical therapy interventions. He has just been admitted to an inpatient rehabilitation facility (IRF) for physical and occupational therapy.
What is the prognosis for independent ambulation for this patient?
What are the most appropriate physical therapy interventions?
What are the examination priorities?
Based on his health condition, what do you anticipate will be the contributors to activity limitations and impairments?
- AMERICAN SPINAL INJURY ASSOCIATION (ASIA) CLASSIFICATION OF SPINAL CORD INJURY: Systematic assessment of sensation, motor, and reflex activity designed for consistent description of persons after spinal cord injury; classification includes determination of a spinal level of injury (e.g., T4) and assignment of an impairment category (i.e., A through E)
- COMPUTED TOMOGRAPHY (CT) SCAN: Series of radiographic images taken from many different angles that uses computer processing to create cross-sectional images
- OVERGROUND AMBULATION TRAINING: Locomotor retraining conducted on the ground without the use of body-weight support and/or treadmills; requires higher equilibrium demand from the patient and is more task-oriented than locomotor training with body-weight unloading
Examine an individual with spinal cord injury to determine his/her American Spinal Injury Association Impairment Scale (AIS) classification.
Identify standardized outcome measures that can detect improvements related to gait and balance for persons with spinal cord injury.
Describe factors that inform prognosis for improvements in gait in persons with spinal cord injury.