Poster 289: Acute Spinal Cord Injury and Infection With Resistant Acinetobacter Calcoaceticus-Baumannii Complex: Successful Innovations in Rehabilitation During Isolation—A Case Report

Abstract

Setting: Spinal cord injury (SCI) unit of a tertiary care hospital. Patient: A 30-year-old active duty Army sergeant who sustained a C5 American Spinal Injury Association grade A SCI from a gunshot wound while serving in Operation Iraqi Freedom. Case Description: We report a systematic retrospective case review of his acute SCI rehabilitation, which was medically complicated by infection with acinetobacter calcoaceticus-baumannii complex contracted while in Iraq. Isolation equipment and protocols were designed to enable regular hands on contact for proprioceptive neuromuscular facilitation, transfers, wheelchair fitting, mobility training, and environmental control. Assessment/Results: After 1 month of comprehensive acute interdisciplinary rehabilitation in an isolated hospital room on the SCI unit, he attained a functional level comparable to C5 complete patients rehabilitated in our unit. Patient and wife team achieved 1-person assist Hoyer lift transfers, wheelchair sitting for 1 hour twice daily, independent recline pressure releases, and joystick control of a power wheelchair, as well as minimum assistance upper-body dressing and independence in self-feeding after setup. The “Yes You Can” educational manual was reviewed in its entirety. Discussion: Concerns about serious infectious organisms are increasing in rehabilitation facilities. Isolation has been implemented to protect patients and staff. Isolation can also potentially challenge patients’ rights of access to medical care, psychologic adaptation, mobility options, and environmental interaction. However, innovations in intervention of rehabilitation practice can improve function in this setting. These challenges were overcome with increased education, greater inclusion of the spouse and primary nurse in the rehabilitation process and scheduled visits of the entire team. Conclusions: If isolation on an SCI unit is necessary, it is still feasible to conduct a comprehensive multidisciplinary rehabilitation program while strictly adhering to contact isolation. Further study is required to establish interdisciplinary protocols for patients and families requiring isolation in the rehabilitation setting.