Amy J. Litterini
Background and Purpose: Transverse myelitis (TM) is a rare condition in which the spinal cord becomes inflamed resulting in pain, paraparesis or paraplegia, impaired sensation, and/or impaired autonomic function. Approximately two-thirds recover with mild to moderate symptoms, but one-third are left with severe and disabling symptoms. Cerebral mycotic aneurysm (CMA) rupture is a brain injury due to a burst artery resulting in diminished blood supply to the brain. There is literature on beneficial physical therapy (PT) intervention progressions following brain injury, such as bed mobility strategies and pre-gait activities, but there is little published on PT for impairments as a result of concurrent TM and CMA ruptures. The purpose of this case report was to describe the PT interventions provided to a patient with paraparesis as a result of TM and multiple CMA ruptures to progress toward achieving his goals of standing and ambulating with a standard walker and bilateral knee-ankle-foot-orthoses (KAFOs). Case Description: The 28-year-old male patient had been seen for two years at an outpatient clinic with an accredited brain injury program. The patient encountered several barriers throughout his rehabilitation, such as repairs to his KAFOs and low bone mineral density, which resulted in a decrease in standing tolerance over time. Outcomes: The Brain Injury Assessment Tool (BIAT) and manual muscle testing were used to document changes throughout the patient’s period of care. No significant changes were observed. Discussion: This patient, despite minimal improvements over a two-year period, may have the potential to increase his trunk control and standing tolerance if he has an extended period of time with no barriers to his rehabilitation.
Tomaswick, Ashley, "Trunk Control And Standing Tolerance Of A Patient With Paraparesis As A Result Of Transverse Myelitis And Mycotic Aneurysm Rupture: A Case Report" (2015). Case Report Papers. 37.