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FROM POSTURAL HYPOTENSION TO THERAPEUTIC WALKING: A CASE STUDY. Jackie Kolesky and Marieta Steyn Physiotherapists Cape Recife High School. Keano. On the 4 September 2010, 13 year old male admitted to St. Georges Hospital after a bicycle accident
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FROM POSTURAL HYPOTENSION TO THERAPEUTIC WALKING: A CASE STUDY Jackie Kolesky and Marieta Steyn Physiotherapists Cape Recife High School
Keano • On the 4 September 2010, 13 year old male admitted to St. Georges Hospital after a bicycle accident • MRI: comminuted # C4 with cord compression, forward compression of C3 on C4 • Surgery C3/4/5 decompression, laminectomy and bone grafting • Ventilated in ICU: tracheotomy, NG tube and in-dwelling catheter
Acute rehabilitation • Admitted to a private rehabilitation hospital on 27 October 2010 • Spent 16 weeks at the facility: intensive speech therapy, occupational therapy, physiotherapy, psychology, nursing, dietitian, doctor • Discharged 18 February 2011 with diagnosis of: • ‘C4 quadriplegic: dependent in all areas’
And now for real life • Joined CRHS in March 2011 • In a manual wheelchair, being pushed by a carer (paid for and supplied by family) • Indwelling catheter, medically managed bowel regime and recurrent bladder infections • He had no hand function: required assistance with eating, writing, dressing etc. • He was a tall, slumped, disinterested teenager with a sadness about him that affected us all.
School rehab • First goal: get Keano to tolerate standing in the tilt table • The benefits of a daily standing programme are: • Protects the hips from dislocating, especially in the non-ambulant • It has a positive effect on bladder and bowel function, which is imperative for the wellness and longevity of the patient • It has a positive psychological effect in terms of looking his peers in the eyes as opposed to have to look up at everyone all the time, promoting self-worth • Improves circulation • Maintains bone density, preventing osteoporosis • Maintains muscle length and joint range
School rehab cont. • Big problem>POSTURAL HYPOTENSION • POSTURAL HYPOTENSION: particularly common in patients with cervical or high thoracic lesions. Primarily due to loss of vasomotor control in the splanchnic area. Blood vessels of the viscera are unable to constrict when the body is raised from horizontal to vertical. Vasomotor control cant be regained but other vascular reflexes can be developed to compensate.
ROAD TO RECOVERY • On placing Keano in the tilt table he would vomit, get dizzy, begin to sweat and feel nauseous. It took weeks to progress Keano through 30˚ elevation→45˚→60˚→90˚ • As Keano had an incomplete injury he had flickers of activity in most of his muscles, his last intact level was C4→schoulder elevation • Keano receives physiotherapy daily for intensive exercise, stretching and Activities of Daily Living training.
