Jason, a 17-year-old, was on track to complete an apprenticeship as a technician when he suffered a spinal cord injury. At the time, he was living with his parents and a younger brother on a rural hillside. When not working, Jason was an enthusiastic and competitive handball player, training four times a week, playing matches each weekend, and competitively doing quite well. He also had a large circle of friends and socialized often.
Three months ago, his life was interrupted after falling 50 meters into a quarry and suffering multiple injuries. He was admitted to a regional trauma center and initially diagnosed with:
- A fractured lumbar vertebra – specifically, a rotation/burst fracture;
- Resulting incomplete paraplegia below L1 (ASIA C at admission);
- A torn nerve root at L1
- A pneumothorax as a result of the fall
- Additional fractures (Sacrum, lower right leg, left foot)
Having been given emergency care and initial stabilizing surgery to the spine at a near hospital he was transferred to the intensive care unit (ICU) of a spinal cord injury center. At this point, he was suffering from significant post-operative pain. In his lower extremities, there were a number of healing fractures requiring immobilization. Therefore, bed-rest had been prescribed.
In addition his sensitivity in his legs was greatly decreased as a result of the SCI. Rehabilitation initially consisted of passive movement of the lower extremity and muscle power training using weights for the upper extremities over the first month. He was gradually allowed to sit in a chair for short times. However, this was limited in duration due to pain in his legs and back and circulation problems. Nevertheless, Jason’s neurological recovery showed improvements throughout the course of this initial phase of rehabilitation.
One month following the injury, Jason underwent a second surgery to stabilize his spine. He was now not allowed to bend and turn his body beyond a certain degree in order for the stabilizing spine implants to heal. Jason thus continued to be confined to bed rest.
Two months after his injury Jason was permitted to begin with standing training in load-relief shoes. However, he began to grow impatient with the restrictions on his movements and craved to test his limits with “real exercises”. The pace of these initial interventions was difficult to accept, especially because he was faced with what felt like an endless period of waiting – a period in which he remained impaired and dependent. It wasn’t until about ten weeks post-injury that he was able to sit in a wheelchair, initially for a 45-minute session, and gradually more each day after.
Increasingly, his functional gains were beginning to show in his test results. His spinal cord independence measure (SCIM) score had increased from 40 to 65, with improvements in mobility and self-care (in bed for pressure sore prevention), respiration, sphincter management (for controlling defecation) and dressing the upper half of the body. Muscle state tests had also demonstrated improvements: assessments shortly after injury resulted in most affected muscle groups showing total paralysis or visible contraction (0 and 1 on a scale of 5, respectively); in this assessment, many had improved to 2 or 3, indicating active movement either without or against gravity. These improvements may have resulted from more regular transfers and healing injuries in his lower extremities.
Although gradual improvements were made, Jason often complained of fatigue during physical exercise. The therapist, however, wondered whether this was actually due to reduced levels of exercise tolerance or a lack of motivation.
With respect to his emotional situation, early on the health care team felt that Jason was introverted, showed emotional instability and phases of depressive mood. Since this substantiated the suspicion of a beginning depression he was therefore prescribed an anti-depressant (Fluoxetin) along with pain medication.
Now three months post injury, a new Rehab Cycle began. Jason’s rehabilitation began to ramp up exercises with a focus on increasing the capacity tolerance to full range of movement and load bearing, including the relearning to walk.