RT300 and non traumatic SCI
The use of FES LE bike in a 22 y/o male with non traumatic
spinal cord injury.
Stephanie Myers, PT, DPT.
This patient was admitted to the hospital on Aug. 16, 2010 for hemoptysis. On Aug. 16, 2010 he had a thoracotomy and left lower lobe wedge resection. He had removal of previous thoracic spine hardware with an aortic interposition graft placement. He was discharged to home on Sept 16, 2010. PMH: Ewing’s Sarcoma involving T8 vertebral body and rib with T8 corpectomy and rib resection. He also had chemotherapy and radiation when he was diagnosed 7 years prior. Pt. received aggressive inpatient rehab. from Aug-Sept. prior to transfer to outpatient PT.
Patient received outpatient PT 4x/wk and aquatic PT 3x/wk from November to March 2010 and then 2x/wk aquatic and 3x/wk land from March to May 2011 and from May to discharge in June 2011, 2x/wk land PT.
Patient did not have any significant events during therapy. He rarely, if ever missed a day of therapy and between Ind. FES 2x/day, aquatic and land PT he was in therapy most of the day. He did well over the course of physical therapy without hospitalizations. He followed up with his Dr. on a monthly basis.
At initial evaluation on September 17, 2010, this pt presented in a manual wheelchair. Gait: He was able to ambulate 90 feet with the use of a FWW and B AFO’s with MOD A. Pt. demonstrated decreased foot clearance with swing through phase of gait bilaterally and utilized his upper extremities significantly with gait. Pt. also demonstrated hyperextension of bilateral knees with stance phase of gait. Balance: Sitting balance was good with upper extremity support at the edge of mat table; static standing with FWW and B AFO’s MIN A, dynamic balance MODJMAX A in standing. Transfers: Pt. performed sit pivot and stand pivot transfers with FWW and MIN A. Sit to stand from wheelchair MIN A, stand to sit to wheelchair MIN A due to leg weakness and pt. plopping into chair. Strength: measured with microfet 2: measures #’s of muscle force: ave of 3 trials in sitting (high setting): R hip flex: 7, L hip flex: 6.7 (3/5 B); all others unable to use microfet secondary to 0 readings; R knee ext 2J/5, L knee ext 2J/5; R and L knee flex 1+/5; R and L hip abd/add 2J/5, R ankle eve: 2/5, L ankle eve: 2J/5, R ankle Inv: 0/5, L ankle Inv: 1/5, R/L ankle DF: 0/5.
Upon discharge: Gait: Pt. was able to ambulate with MI using SBQC and B AFO’s x 200 feet with improved step length. He was able to reach into cupboards to get out plates, carry plate to the table, carry syrup bottle to table and carry water jug full to and from the table with SBA and no loss of balance using SBQC. Balance: Pt. scored 21/28 with SBQC on Tinetti gait and balance test using B AFO’s. Transfers: Pt. was able to perform sit<>stand and SPT with SBQC and MI. Strength: re-tested with Microfet 2 (measures #’s of muscle force: ave. of 3 trials on high setting) R hip flex: 23 (4/5), L hip flex: 20.3 (4/5 ); R knee ext: 10 (3/5), L knee ext: 6 (3/5) ; ( he was unable to get >0 in previous months), R hip abd: 13.7, L hip abd: 17, R hip add: 13.7, L hip add: 9.3; In sidelying: R hip abd: 26.3; L hip abd: 18.7 (4/5 B); R knee flex with roll between knee and support at knee to avoid substitution: 4.3, L knee flex: 5; R and L ankle DF 1/5, R and L ankle Inv 2/5, R ankle L ankle Eve: 3/5.
Treatment consisted of neuromuscular re-education, therapeutic exercise, therapeutic activity, gait training, aquatic ther-ex and FES bike program. The addition of FES LE cycling was very important with this patient’s recovery. He received electrical stimulation to bilateral quads, hamstrings and gluteals initially with progression to more distal facilitation when his strength improved. He wanted to use the bike 2x/day. He was taught how to set up and take down and performed Independent FES bike
program 2x/day on most days for 30 minute sessions in addition to 45 minute sessions of land and aquatic PT. He was very involved in his care and through the use of electrical stimulation; he was able to progress with his overall strength, balance, gait and independence with functional mobility. He stopped by the clinic approximately 2 months after discharge and he reached his goal of being able to use a STC in the community and was able to live independently in his own home. The LE FES bike was very vital in the success and progression of this patient. It has been highly utilized in our clinic and will continue to be an important tool in recovery for our neurological population.