Date of Paper/Work

3-2011

Degree Name

Doctor of Physical Therapy

Department

Physical Therapy

First Advisor

Debra O. Sellheim, PT, PhD

Abstract

BACKGROUND AND PURPOSE: While infections are common and typically easy to treat, they can have serious implications when they occur near the spinal cord. Spinal epidural abscess (SEA) is a diagnosis rarely reported in the physical therapy (PT) literature. The purpose of this case report is to describe the course of inpatient PT treatment and functional gains for a patient with a SEA caused by S. aureus infection. CASE DECSRIPTION: The patient was a 67-year-old male with a diagnosis of C3 tetraplegia, ASIA C classification, as a result of a SEA at C3-4. Prior to the onset of symptoms related to the SEA, he was in good health with no serious co-morbidities and completely independent in activities of daily living (ADL) as well as instrumental activities of daily living (IADL). During his seven week inpatient stay, the patient participated in treatment 5-7 days per week. Interventions fell into the following categories: transfers, mobility and ambulation, strengthening, balance, endurance, manual stretching, soft tissue mobilization, and modalities for pain control. Interventions were progressed with increasing difficulty and decreasing assistance in all categories according to patient performance.

OUTCOMES: Over the course of treatment, the patient was able to progress from total assist for transfers and all functional mobility to modified independence for transfers and community ambulation with a four wheeled walker.

DISCUSSION: Despite having a cervical SEA, which is correlated with poorer motor outcomes, the patient demonstrated rapid and meaningful functional gains. While this result supports previously reported potential for functional recovery, the patient’s level of injury and delayed motor return make his case unlike others in the literature. Although gold standards for medical and surgical techniques are well represented in the literature, there is a lack of PT-related literature concerning SEA. Conflicting evidence has been reported regarding motor improvements following rehabilitation for patients with SEA. Areas for further research exist in the realm of PT as well as quality of life outcomes following SEA.

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