Kevin Horner PT Outpatient Rehabilitation
Sanford Health, Sioux Falls, SD

Wellness Program health benefits for individual with Transverse Myelitis

History
Patient is a 32 y/o female who was diagnosed with idiopathic transverse myelitis at the age of 15.  Pt developed secondary paraplegia T1-T4 secondary to transverse myelitis and lupus.  Pt has been manual wheelchair dependent since this time.  Over the course of her 17 year paraplegia she has had numerous health related issues develop secondary to inactivity.  She has developed secondary osteopenia due to inactivity which has resulted in R femur fractures in 2006 and again in 2010 with rod placement in 2010.   Kristi had a dexa scan at Mayo clinic in June of 2011(BMD of 0.574 g/cm (sq), T score of -3.5) and again in July of 2012(BMD of0.587 g/cm (sq), T score of -3.3). This is an increase of 2.3% in bone density year over year.   She has developed increased spasticity over the 17 year course with increased neurogenic bowel and bladder.  Baclofen has been utilized for control of spasming in which Kristi weaned from in June of 2012.  Weaning from the baclofen was a personal choice as Kristi has gotten spasm relief with utilization and exercise with the FES bike which was initiated in June of 2012.  Over the years she has also developed pressure sores, low back issues and has increased weight secondary to inactivity.  Pt was accessed for introduction into Sanford’s Accessible Wellness Program on March 17th of 2012 with the inclusion of the FES bike.  At six months a follow-up assessment was completed on September 28th of 2012 with the following objective measurements taken.

Grip strength
On March 17th her grip strength measured 65# and 55# in two trials on the R and 64# and 54# on the L.  Her R pinch measured 10# and 9# and L measured 8# and 8#.  After undergoing 6 months of exercise including FES bike 2-3/week she was remeasured at 66# and 66# (+6# avg) for R grip, 72# and 75# (+14.5#avg) for L grip, her R pinch measured 17# and 16# (+7# avg) and L pinch was 16# and 14# (+7#avg)

Weight Loss
On March 17th of 2012 Kristi was weighed in at 176.2# and after undergoing 6 months of Wellness activity including use of the FES bike 3x/week, she was reassessed and had a decrease in weight of 4.2# down to 172#.

Heart Rate/Oxygen Saturation
Resting heart rate went from 110 beats per minute (BPM) to 91BPM with oxygen saturation increasing from 97% to 99%, both measured via pulse oximeter.

Quality of Life survey
Pt was given a Ferrans and Powers Quality of Life Index-Spinal Cord Injury version-III.  Her overall score quality of life score increased from her initial assessment to the six month assessment from 385 total points to 402.  This is an increase in score from an average of 5.6 to 5.9 over the six month period of time.  The Ferrans and Power Quality of Life Index scale is scored as following.

1 Very dissatisfied
2 Moderately dissatisfied
3 Slightly dissatisfied
4 Slightly satisfied
5 Moderately satisfied
6 Very satisfied

Accessible Wellness Treatment

Program started on March 17th, 2012 at which time the FES bike was initiated on March 23.  The primary exercise component consisted of 1 hour of FES bike utilization as well as independent U/E strengthening exercises.  Kristi has regularly and consistently participated in the Accessible Wellness Program and has logged 157 sessions for a total of 124 hours.  She has cycled 862 miles, burning 245,040 total calories and improving her health in some very significant ways!

Specific progress using the FES cycle for the last year includes:

  • 378 % increase in energy expended per session when comparing the average energy expenditure per session from her first five to her most recent five sessions.
  • 500 % increase in distance cycled since beginning at the wellness center with typical distance per cycling session now typically 7-10 miles for each one hour session

Benefits include cardiopulmonary conditioning, improved circulation, improved and maintained range of motion, reversal of muscle atrophy and reduction in spasms.  As stated earlier, she has also experienced some other medical benefits including the elimination of the spasticity medications, no recurrence of pressure sores that were once a significant problem, and improved bone density.

“I really enjoy riding the FES cycle for numerous reasons, but I am excited to see the increase of bone density in my legs. It makes my doctors happy and it decreases my chances of another break significantly. I have already gone through two broken femurs and I don’t want to do it again. My spasms aren’t totally gone, but they are manageable. I see the difference in the strength of my legs especially during a spasm. I hope this leads to standing and time in the pool in the very near future”. -Kristi Allen