Date of Paper/Work

4-2015

Type of Paper/Work

Research Project

Degree Name

Doctor of Physical Therapy (DPT)

Department

Physical Therapy

First Advisor

Lisa L. Dutton

Abstract

BACKGROUND AND PURPOSE: Falls are the second leading cause of spinal cord injury and the average age at time of injury has been increasing over the last several decades. Current estimates suggest that the annual incidence of spinal cord injury (SCI) in the geriatric population (>65 years of age) is 67.9/million. According to the National Institute of Neurologic Disorders and Stroke, the most common form of incomplete spinal cord injury is Central Cord Syndrome (CCS) which typically presents with greater upper versus lower extremity impairment. The primary objective of this case report was to describe interventions and management for a patient with symptoms of Central Cord Syndrome following a suspected hyperextension injury.

CASE DESCRIPTION: The patient was a 76-year-old retired construction worker who developed CCS as a result of a fall from a tractor. He presented with significant weakness, greater in the upper extremities than the lower extremities, and limited knee range of motion (ROM). This individual also displayed activity limitations related to sitting, standing, balance, transfers, stairs, and ambulation. Other pertinent past medical history included arthritis in both knees, spinal degenerative joint disease (DJD), and spondylolysis.

INTERVENTIONS: Treatment interventions consisted of stretching, therapeutic exercises and activities, aerobic conditioning, stair training, transfer training, gait training, patient education and aquatic therapy.

OUTCOMES: By the end of therapy the patient’s Berg score had improved by 24% from 21 points to 34. He was able to ambulate approximately 360 feet in 6 minutes; 30% of his age-predicted norm. After 10 weeks (approximately 110 treatments) the patient was discharged home with recommended physical therapy (PT) homecare services. He was independent with bed mobility, required occasional supervision for safety on transfers, and was walking 500 feet using a front wheeled walker, requiring stand-byassist (SBA).

DISCUSSION: This case report describes a patient’s rehabilitation process following a spinal cord injury secondary to a fall with recovery being limited by the orthopedic condition of his knees. Additional randomized control trials to compare physical therapy interventions with other management of CCS would be beneficial in order to determine the effectiveness of physical therapy for this patient population.


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