Case presentation of a patient with an onset of psychotic disorder, polytraumatized by defenestration from 10th floor, with thoraco-lumbar SCI and multiple somatic fractures, with favorable neuro-motor and psychiatric evolution after rehabilitation

Abstract

Introduction: Traumatic fractures of the spine are most common at the thoracolumbar junction and can be a source of great disability. Most of them occur due to motor vehicle injuries and falls from a height. Since these are high-velocity injuries, thoracolumbar fractures are commonly associated with other injuries like rib fractures, pneumo-hemothorax, and rarely great vessel injuries, hemopericardium and diaphragmatic rupture. Materials and Methods: In this article - having the patient and the THEBA Bioethics Committee approval (no. 3159/30.01.2020) – it is presented the case of a 26-year-old patient who suffered a polytrauma due to defenestration from the 10th floor - about 30 m high -resulted in thoraco-lumbar SCI associated with other severe injuries, hospitalized in Neuromuscular Clinical Division by transfer from the Neurosurgery Clinic of our hospital, for neuromotor recovery, presenting a L1 AIS/ Frankel C quadriplegia and neurogenic bladder. During the hospitalization, the patient presented psychomotor agitation, food and medication rejection, which is why repeated psychiatric evaluations were requested and performed. Following the recovery program, the patient's evolution was favorable: recovered the weight deficit, improved the motor control and sensitivity, the urethral indwelling catheter was suppressed and the intermittent catheterization program was started with later regaining of the micturition control. The patient was assessed functionally using the following scales: AIS/Frankel, modified Ashworth, Functional Independence Assessment (FIM), Life Quality Assessment (QOL), FAC International Scale, Independence Assessment Scale in Daily Activities (ADL/IADL). Results:The patient benefited from a complex program of neuromuscular rehabilitation, with a favorable evolution, with the increasing scores from the evaluated scales and, thus, with a final performance of walking with support on short distances, as well as a sphincter reeducation with the neurogenic bladder remission. Conclusions: Associating interdisciplinary approach with a customized rehabilitation program in a patient with an onset of psychotic disorder, polytraumatized by defenestration from the 10th floor, with thoraco-lumbar SCI and other severe injuries led to neuromotor and psychiatric improvements, and sphincter function reeducation with an important improvement in patient's quality of life. Keywords: neuromuscular rehabilitation, traumatic spinal cord injury, psychiatric disorder, polytrauma,