CASE ANALYSIS 1
WRITTEN OUTPUT
SPINAL CORD INJURY
Submitted by:
GROUP 2 GOODMAN
ALON, Ayana
CASTANEDA, Dominic
CHUA, Fritz
GERZON, Kurt
PEDIONGCO, Carol
SITCHON, Shania
VELASCO, Miguel
YAP, Jerika
A 52-year-old male sustained an INCOMPLETE cervical SCI while body surfing. The injury was
graded as American Spinal Injury Association (ASIA) Impairment Scale C. Acute magnetic
resonance imaging of the cervical spine revealed hemorrhage and contusion of the spinal cord at
C3/4 in the setting of severe spinal stenosis. Cervical X-rays and CT imaging were obtained in order
to rule out bony fracture or instability. The patient was initially treated conservatively
Following modest initial functional recovery, progress came to a halt and repeat cervical MRI four
months after injury revealed spinal myelomalacia at C3/4 in the setting of severe cervical spinal
stenosis.
The patient was admitted to the inpatient rehabilitation unit wearing a cervical orthosis. He was
provided with a sip-and-puff call light in his room.
He participated in standard inpatient physical rehabilitation for three months that included
occupational therapy and gait training. At discharge, his neurological level of injury and AIS category
did not change. Despite adequate muscle strength in both lower and left upper extremities, he was
completely dependent for all self-care activities (feeding, bathing, dressing, grooming, bowel and
bladder management), and had limited indoor walking with moderate assistance for transfers,
standing, balance and stepping.
TEST AND MEASURES: See ASIA SCALE for sensory and motor assessment.
Sitting Balance:
Maximal assistance for short-sitting balance on mat without UE support.
Moderate assistance for short-sitting balance on mat with bilateral UE support for 30 seconds.
Modified Functional Reach Test: unable to complete secondary to loss of balance
Transfers, Locomotion, and Upright Tolerance:
Functional Independence Measure (FIM)
Transfers bed = 1
Transfers toilet = 1
Transfers tub/shower = 1
Locomotion wheelchair = 1
Locomotion stairs = 1
LTG: Pt will be able to perform self care activities, transfers et locomotion c min assist, et complete
the modified functional reach test s loss of balance p 1 yr PTR.
Short- Term Goal (3 mos)
Goal
Pt. will be able to manifest an ↑ in self-care
scores on the SCIM III from 0 → 12 p 3 mos of
PTR
Pt. will be able to manifest an ↑ in FIM scores for
transfers of the ff categories: bed, toilet,
tub/shower from 1 → 4 p 3 mos of PTR
Treatment
1. PNF: Rhythmic Initiation in D1 et D2 Flex
and Ext. pattern on bilat. UE x 10 reps x 2
sets
2. PNF: Stabilizing reversal in D1 et D2 Flex
and Ext. pattern on bilat. UE x 10 reps x 2
sets
3. PNF: Task Replication of ADLs: self care(
Feeding,Bathing,Dressing on B UE et LE,
Grooming x 10 reps x 3 sets
4. MRP: object reaching From Table x 10
reps x 3 sets
5. 2lb medicine ball Chest press x 10 reps x
3 sets
1. MRP: standing up components x 10 reps
x 3 sets each
2. Bed mobility ex x 10 reps x 3 sets each:
a. supine ⇆ side lying ⇆ sitting
b. w/c ⇆ bed
3. NDT: exercise for standing from high
chair to low chair x 10 reps x 3 sets
4. push up c gymball x 10 reps x 3 sets
5. Trunk Balance on sitting position hold for
10 sec. x 3 sets
Pt. will be able to manifest an ↑ in FIM scores for
locomotion of the ff categories: walking/wc, stair
negotiation from 1 → 4 p 3 mos of PTR
Pt. will be able to manifest an improvement in
sitting balance as evidenced by going from max
1. Box Squats c clasped hands 10 reps x 3
sets
2. Stationary cycling x 10 mins
3. Stair negotiation using quad cane c min
assist for 15 mins x 2 sets
4. BW Calf Raises c // x 10 reps x 2 sets
5. Standing weight shifting c // x 10 reps x 3
sets
1. PNF: Contract Relax (indirect treatment)
in sitting position on B UE c 3.7 lb of
dumbbells 10 reps x 3 sets
2. Bobath equilibrium ex in short sitting c et
s UE support x 10 reps x 3 sets.
assist. for short sitting balance on mat s UE
support → mod. assist p 3 mos of PTR
3. Sitting weight shifting x 10 reps x 3 sets
4. PNF: Dynamic Reversal towards
short-sitting trunk flexion et extension c
UE support 10 reps x 3 sets.
5. perturbation: short sitting x 10 reps x 3
sets
Short-Term Goal (6 mos)
Goal
Treatment
Pt will be able to ↑ mm strength on R finger
flexors et abductors from 0 → 2; L finger flexors
et abductors 1 → 3; et bilat elbow flexors, wrist
extensors, elbow extensors from 1 → 2; bilat. hip
flexors, knee et toe extensors, ankle
plantarflexors et dorsiflexors from grade 2 → 4 p
6 mos PTR.
1. NMES on bilat elbow flexors et extensors,
wrist extensors, finger flexors et
abductors x 35 pps, 135 ms x 10 mins.
2. PROM ex towards elbow flex et ext, wrist
flex et ext x finger flex et abd. 15 reps x 2
sets c 6 sec. hold.
3. Isometric exercise on bilat. elbow flexors
et extensors, wrist extensors, finger
flexors et abductors 10 reps x 3 sets.
4. Tendon blocking and gliding exercises x
10 reps
5. AROM towards bilat. hip flex. knee ext,
ankle plantarflexion et dorsiflexion 10
reps x 3 sets.
a. Progress to PREs c yellow
theraband 10 reps x 3 sets.
Pt. will be able to improve self-care activities
such as feeding, bathing, dressing, et grooming
from total dependence (1) to mod assist. (3) p 6
mos PTR.
1. PNF: Rhythmic Initiation in D1 et D2 flex
et ext. pattern on bilat. UE 10 reps.
2. MRP: Components involving the hand x
10 rep.
3. MRP: Components in reaching x 10 reps
each.
4. PNF: Stabilizing-Reversal in D1 et D2 flex
et ext pattern on bilat UE x 10 reps
5. PNF: Replication of tasks such as
feeding, bathing, dressing, grooming 10
reps.
Pt. will be able to perform transfers, standing,
balance, et stepping from mod assist. (3) to min.
(4) assist p 6 mos. PTR.
1. Bed mobility ex x 10 reps each:
a. supine ⇆ side lying ⇆ sitting
b. w/c ⇆ bed
2. MRP: standing up components x 10 reps
each
Bobath Techniques x 10 reps each:
3. exercise for standing from high chair to
low chair
4. exercise for ambulation 3 in standing
position
5. equilibrium ex c perturbations
Pt. will be able to improve short-sitting balance c
bilateral UE support from 30 secs → 1 min et s
support from max assist. to min. assist. p 6 mos
PTR
1. MRP: balance short-sitting c et s bilat UE
support x 10 reps.
2. Weight shifter and arm raiser in
short-sitting position c UE support x 10
reps.
3. Bobath equilibrium ex in short sitting c et
s UE support x 10 reps x 3 sets.
4. PNF: Dynamic Reversal towards
short-sitting trunk flexion et extension c
UE support 10 reps x 3 sets.
5. PNF: Stabilizing Reversal towards
short-sitting trunk flexion et extension s
UE support c max assist from PT 10 reps
x 3 sets.
Short-Term Goal (1 year)
Goal
Pt. will exhibit an increase in FIM score in
standing balance, stepping, transfers from a
score of 4 (min. assist) → a score of 5
(supervision) p 1 yr of PTR.
Treatment
1. Ambulation on leveled surface inside the
// 10 reps x 3 sets
2. Sit to stand 10 reps x 3 sets
Bobath technique:
3. Equilibrium exs: perturbation in standing
position 10 reps x 3 sets
4. Cross legging in standing position c
walker on B LE 10 reps x 3 sets
5. Moving a small trolley in standing position
c walker on B LE 10 reps x 3 sets
a. Progression: sideways 15 reps x 3
sets
Pt. will achieve a functional indep in ADLs, such
PNF Technique:
as bathing, eating, dressing, grooming et
mobility to continue et maintain strength of UE et
1. PRE’s D2 flexion in standing position on
LE p 1 yr of PTR.
B UE c using red theraband 10 reps x 3
sets
2. Contract Relax (indirect treatment) in
sitting position on B UE c 3.7 lb of
dumbbells 10 reps x 3 sets
3. PRE’s bilat. D1 flexion et D2 extension
symmetrical in sitting position c using red
theraband 10 reps x 3 sets
4. PRE’s D1 flexion in sitting position on B
UE c using red theraband 10 reps x 3
sets
Bobath Technique:
5. Trunk Balance on sitting position hold for
10 sec. x 3 sets
a. Progression - hold for 15-20 sec. x 3 set
6. Squats c clasped hands 10 reps x 3 sets
7. bridging c clasped hands 10 reps x 3 sets
Pt will be able to improve stair locomotion on
FIM score from 1 (max assist) → 4 (min assist) p
1 yr of PTR.
1. Bobath: Exercise for ambulation 3 in
standing position x 10 reps x 3 sets.
2. Step ups c quad cane on step stool of B
LE x 15 reps each leg.
3. Lateral step ups on step stool of B LE x
15 reps each leg x 2 sets
4. Stair negotiation using quad cane c min
assist for 15 mins x 2 sets
5. Forward lunges c yellow theraband x 15
reps
Pt. will be able to complete modified functional
reach test s loss of balance from being unable to
complete p 1 yr of PTR.
1. MRP: Components in reaching in sitting x
10 reps each
2. MRP: reaching forward and sideways s
assist for 15 reps x 2 sets to ↑
complexity
3. Arm forward raiser in short-sitting position
s UE support x 10 reps.
4. PNF: Rhythmic Initiation in sitting towards
trunk flexion x
5. PNF: Dynamic Reversal towards
short-sitting trunk flexion et extension s
UE support 10 reps x 3 sets