Authors:
Astrina Nur Bahrun
and
Andriati
Affiliation:
Universitas Airlangga, Indonesia
Keyword(s):
Traumatic, spinal cord injury, return to work, vocational rehabilitation
Abstract:
Background: Traumatic spinal cord injury (SCI) has devastating consequences for the physical, social and vocational well-being of patients. Sensoric and motoric damage may disrupt the bowel and bladder. Objective: To report the rehabilitation of a burst fracture of the 12th thoracic vertebra caused by spinal cord injury. Case description: A 54-year-old man became paraplegic after a fall from about 2 meters’ height when he stood on a brittle wooden plank, falling into a sitting and then lying position. After the incident, his bilateral lower limbs showed decreased strength with sensory loss from L1 and below, pain at the back area VAS 3 when moving his lower extremity, but bowel and bladder were normal. He was diagnosed with T12 paraplegia AIS C due to a burst fracture of the 12th thoracic vertebra. The patient underwent Pedicel Screw & Rod (PSR) surgery. Discussion: Our rehabilitation goals were to prevent further impairment, avoid long immobilization, ambulation with or without ass
istive devices and return to work as a mechanic. He used a thoracolumbosacral orthosis (TLSO) Flexion Extension Lateral (FEL) control for early mobilization after the surgery. He received electrical stimulation at the ankle dorsi and plantarflexor whose muscle strength was still 1 at 3 weeks after surgery, and range of motion, sensory reeducation, pain management and endurance exercises. There were improvements in muscle strength, especially in the ankle dorsiflexor (1/1 to 3/4), long toe extensor (1/1 to 1/4), and ankle plantarflexor (1/1 to 4/4). There was sensory deficit from L1 and below to L2 and below. The level of Asia impairment scale was from C to D. He didn’t use the brace anymore and managed independent ambulation without an assistive device, but still could not return to work 1 year after the surgery. The main findings were a strong conviction about the ability to work, but time was needed first, to create new routines in his daily life. The major obstacles were described as lack of education, lack of work experience, sick mindset, and perceived limitations due to the injury. Conclusion: Early rehabilitation programs and early mobilization with a brace after surgery prevent long immobilization complications. Comprehensive management including vocational rehabilitation due to his productive age and recent injury was needed.
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