The impact of physiotherapeutic management based on selected neurophysiological assessment methods on the quality of life and functional status in a patient after C1 and C2 level trauma: A Case Study

Abstract

Spinal cord injury (SCI) is frequently linked to chronic disorders that cause functional challenges in the sensorimotor system. Early, comprehensive, and continuous physiotherapy after spinal cord injury, starting from the preoperative stage, through several years improves the patient’s functional status and independence. Material and methods: The patient is a 51‑year‑old miner hospitalized in the Neurosurgical Department of 4WSKzP in Wrocław. He suffered a cervical spine injury in a mining accident. Moreover, he was found to have a type III odontoid fracture with intramedullary displacement (1.2 cm) and an atlas arch fracture without displacement. The patient’s functional status was assessed using: SCIM III, ASIA, and FIM scales.The aim of the study: The purpose of this study was to assess the effectiveness of 4 years of physiotherapy based on neurophysiological methods and its benefits for a patient after spinal cord injury at the C1 and C2 levels. Results: During the first 36 months of therapy, a marked improvement in sensation was observed, with a slight dominance on the left side until the 24th month, followed by stabilization of the values. In the third month, a consistent increase in the muscle strength of both upper extremities was noted, showing a steady linear progression. Independence in daily activities, scored according to the FIM scale, also showed improvement in parameters until the 48th month of therapy. Independence in self-care, scored according to the SCIM III scale, was at 14 points until the first year of treatment, and reached 20 points by the end of the therapy. Assessment of respiratory function and sphincter control, allows us to conclude that the greatest improvement was achieved in the first 3 months of continuous treatment, i.e. from 0 to 17 points, after 12 months; 23, after 48 months the patient scored a total of 40 points. In terms of transfers in the home environment, improvements were observed up to the 12th month of therapy. The greatest rate of change in mobility was observed during the first 2 years of treatment. At 36 and 48 months of therapy, the improvement in mobility maintained a modest increasing trend. Conclusions: A beneficial effect of 4 years of physiotherapy was observed in the functional status and independence of the patient after severe SCI. As a result, he was able to drive a passenger car independently.