Document Type

Case Report

Department

Physical Therapy & Rehabilitation Science

Degree Name

DPT (Doctor of Physical Therapy)

Session and Year of Graduation

Fall 2019

Advisor

Frey Law, Laura

Abstract

Background: Transverse myelitis (TM) is a rare inflammatory condition that disrupts spinal cord function and leads to sensory, motor and autonomic dysfunction below the neurological level. While medical management and patient outcomes rely heavily on diagnostic timing and accuracy, multidisciplinary care including acute physical rehabilitation is recommended to maximize functional independence and quality of life of affected individuals. Purpose: This report discusses the rehabilitation course of an individual with a severe case of TM following varicella zoster, West Nile and mycoplasma infections. Medical details are also shared to illustrate the rare nature of this case. Case Description: A 58-year-old Caucasian male (Client A) without remarkable medical history presented with a slow onset of neurological symptoms leading to paralysis four weeks after an episode of shingles. A late diagnosis of longitudinally extensive transverse myelitis was confirmed yet no single infectious agent was identified as the cause. Through rehabilitation, he learned functional mobility skills but experienced minimal neurological recovery and remained non-ambulatory at discharge. Interventions: Medical treatments used to target neurological recovery included acyclovir, doxycycline, corticosteroids, plasmapheresis and intravenous immunoglobulin. Client A also participated in inpatient rehabilitation dosed at three hours per day, five to six days per week, for nine weeks. Interventions included task-specific training, seated balance training, functional electrical stimulation and weight-bearing exercises. Outcome Measures: ASIA Impairment Scale, Functional Independence Measure, Modified Ashworth Scale, Range of Motion, and Manual Muscle Testing measures. Discussion: The increased time required to diagnose Client A, along with his adverse reactions to standard medical treatments, may have negatively impacted his prognosis. Despite this, he improved in all outcome measures with inpatient rehabilitation and was discharged to his home.

Keywords

Transverse myelitis; postinfectious; physical therapy; rehabilitation; non-ambulatory

Pages

12 pages

Copyright

Copyright © 2019 Gillian Feller

COinS
 

URL

https://ir.uiowa.edu/pt_casereports/84