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The patient is a 57-year-old female who has had acute and progressive onset of numbness and tingling in the lower extremities, mild mid- to low back pain, and bowel and urinary incontinence over the past 10 days. She reports that the signs and symptoms have plateaued. She is currently unable to walk and was admitted to the hospital for a complete medical work-up. She has no significant prior medical history, but relevant family history includes a paternal grandmother with multiple sclerosis. Prior to this hospitalization, the patient was living in a single-level home with her spouse and was independent in all activities of daily living. She is unemployed, and does not currently exercise on a regular basis. She reports an inability to walk and numbness and tingling in her legs as if she has been out in the cold too long. She states that she has been unable to get around the house independently since the onset of her symptoms. Since admission to the hospital, she has not been out of bed. Magnetic resonance imaging of the thoracic and lumbar spine showed abnormal increased T2 signal and enhancement along the posterior half of the spinal cord from approximately T10 to T12. The neurologist diagnosed idiopathic acute transverse myelitis. The patient was started on high-dose intravenous glucocorticoid therapy, and was referred to physical therapy for evaluation and management.

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How would her contextual factors influence or change your patient/client management?

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What are the complications interfering with physical therapy?

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

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What are the most appropriate physical therapy interventions?

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What are the examination priorities?

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Based on her diagnosis, what do you anticipate will be the contributors to activity limitations?

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  • AUTONOMIC DYSFUNCTION: Malfunction of the autonomic nervous system; signs include urinary incontinence or retention, bowel incontinence or constipation, and sexual dysfunction
  • PAROXYSMAL TONIC SPASMS: Involuntary temporary dystonic contractions of limb or trunk muscles
  • T2-WEIGHTED MAGNETIC RESONANCE IMAGING (MRI): Type of MRI scan in which fluid appears bright in the image; in the case of acute transverse myelitis, bright areas (denoting increased signal) indicate inflammation

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  1. Describe the typical signs and symptoms of acute transverse myelitis.

  2. List pertinent physical therapy tests and measures for the individual with acute transverse myelitis.

  3. Discuss appropriate physical therapy interventions for an individual with acute transverse myelitis.

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PT considerations during management of the individual with acute transverse myelitis in the acute care setting:

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  • General physical therapy plan of care/goals: Improve functional mobility; prevent or minimize loss of range of motion (ROM) and aerobic functional capacity; identify and address secondary complications of immobility; maintain skin integrity
  • Physical therapy interventions: Patient education regarding skin care and ROM; functional mobility training; ...

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