ABSTRACT
Hemicorporectomy (HCP) is infrequently used, but its effects can devastate the patient's body image, autonomic function, and physical abilities even more than a spinal cord injury of comparable level. Interdisciplinary management is of the utmost importance. This report describes the 2 year course, including four separate rehabilitation admissions, of a patient who was initially paraplegic, and then underwent a HCP for complications secondary to a cauda equina ependymoma. The patient's expectations for functional independence were established by his successful initial spinal cord rehabilitation. The HCP was performed 6 months after initial discharge secondary to infected Harrington rods and rapid spread of the tumor. Extensive use of the interdisciplinary team approach allowed comprehensive analysis and treatment of the patient's comfort, mobility, skin tolerance, and upper extremity functional abilities. Four successive prostheses were developed and modified, until all concerns were successfully addressed. The patient ultimately became completely independent at the wheelchair level. The evaluations, treatment plan, and emphasis of each discipline, including physical therapy, occupational therapy, rehabilitation nursing, therapeutic recreation, social work, vocational rehabilitation, and physiatry are summarized. Differences between the patient's course and standard spinal cord rehabilitation are detailed.
Subject(s)
Amputees/rehabilitation , Cauda Equina/surgery , Ependymoma/complications , Nerve Compression Syndromes/etiology , Paraplegia/rehabilitation , Spinal Cord Neoplasms/complications , Adult , Combined Modality Therapy , Ependymoma/therapy , Goals , Humans , Male , Nerve Compression Syndromes/complications , Nerve Compression Syndromes/surgery , Occupational Therapy , Paraplegia/etiology , Patient Care Team , Physical Therapy Modalities , Spinal Cord Injuries/rehabilitation , Spinal Cord Neoplasms/therapyABSTRACT
A mailed survey was conducted to collect information about the application of hand splints to patients with spinal cord injuries resulting in quadriplegia at levels C-5, C-6, C-7, and C-8. Survey respondents were occupational therapists in spinal cord injury centers nationwide. Frequency and descriptive statistics were collected concerning both static and dynamic splints, the clinical reasoning behind splint selection, and methods used for the evaluation of hand function. The results of the survey indicate that hand splinting is an accepted intervention for the target population. A variety of static splint designs were used, depending on level of injury, muscle strength, and the patient's acceptance. The dynamic splint designs were used most frequently with patients whose lesions were at C-6 and C-7. The reasons for not splinting were primarily related to the patient's compliance and acceptance. Observation of patients' performance of functional tasks was the preferred method of evaluation of hand function, as there are no appropriate standardized tests available for this population.
