Activity-based Rehabilitation After Incomplete Spinal Cord Injury Due To Pott's Disease: A Case Study

Abstract

<h3>Research Objectives</h3> To explore the effectiveness of activity based rehabilitation (ABR), partial body weight supported treadmill training, and a comprehensive home exercise program (HEP) for return of motor function, mobility, and gait in a person with incomplete SCI due to Pott's disease (spinal tuberculosis), To assess effectiveness of ABR, treadmill training, plus performance of HEP for functional return with limited in person visits (due to pandemic and insurance restrictions), To investigate the effectiveness of ABR, partial body weight supported treadmill training, and HEP in returning to community ambulation following incomplete SCI due to Pott's disease. <h3>Design</h3> Case study, followed for 6 months. <h3>Setting</h3> Hospital based outpatient clinic. <h3>Patient</h3> A 52 year old female with incomplete T9-10 SCI due to spinal tuberculosis (Pott's disease) <h3>Interventions</h3> Patient was seen 1-2x/week x 6 months. She participated in ABR in the clinic 1-2x/week and via HEP daily, partial body weight supported treadmill training in the clinic 1x/week, overground gait and balance training in the clinic 1-2x/week, and stretching and strengthening via HEP daily. <h3>Main Outcome Measures</h3> Walking index for spinal cord injury (WISCI), 10 Meter walk, 5x sit to stand, 6 minute walk. <h3>Results</h3> Statistically significant improvements were demonstrated on all outcome measures. The patient's WISCI improved from Level 8 to level 16. Her gait speed improved from 0.2m/s to 0.58m/s with front wheeled walker (and to 0.38m/s with bilateral loftstrand crutches) per 10 Meter walk test, demonstrating a progression from a home ambulator to a limited community ambulator. Her 6 minute walk test improved from 14% to 26% of age predicted normative values. Her mobility also improved as demonstrated by a 24 second improvement in 5x sit to stand test. Overall, patient demonstrated motor return, improved mobility, and improved gait speed and distance with less restrictive assistive device after a combination of ABR, partial body weight supported treadmill training, and following a comprehensive HEP. <h3>Conclusions</h3> ABR and partial body weight supported treadmill training can be utilized as effective interventions for a patient with incomplete SCI due to Pott's disease (spinal tuberculosis). This patient had limited in person visits due to insurance restrictions, and was also given a comprehensive HEP to supplement skilled PT sessions. She demonstrated gradual improvements throughout her bout of care, supporting the use of this model with other patients with SCI due to Pott's disease. Further research is needed to determine most appropriate dosing of each intervention. <h3>Author(s) Disclosures</h3> None.