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PMID- 28834891
DA  - 20170823
DCOM- 20170912
LR  - 20170912
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 34
DP  - 2017 Aug
TI  - Interdisciplinary rehabilitation for a patient with incomplete cervical spinal
      cord injury and multimorbidity: A case report.
PG  - e7837
LID - 10.1097/MD.0000000000007837 [doi]
AB  - RATIONALE: This report describes interdisciplinary rehabilitation for a
      51-year-old male recovering from incomplete cervical spinal cord injury (SCI) and
      multiple comorbidities following an automobile accident. PATIENT CONCERNS: The
      patient was admitted to a rehabilitation specialty hospital approximately 2
      months post SCI and 2 separate surgical fusion procedures (C3-C6). DIAGNOSES:
      Clinical presentation at the rehabilitation hospital included moderate to severe 
      motor strength loss in both upper and lower extremities, a percutaneous
      endoscopic gastronomy tube (PEG), dysphagia, bowel/bladder incontinence,
      dependence on a mechanical lift and tilting wheelchair due to severe orthostatic 
      hypotension, and pre-existing shoulder pain from bilateral joint degeneration.
      INTERVENTIONS: The interdisciplinary team formally coordinated rehabilitative
      care from multiple disciplines. Internal medicine managed medications, determined
      PEG removal, monitored co-morbid conditions, and overall progress. Chiropractic
      care focused on alleviating shoulder and thoracic pain and improving spinal and
      extremity mobility. Physical therapy addressed upright tolerance, transfer, gait,
      and strength training. Occupational therapy focused on hand coordination and
      feeding/dressing activities. Psychology assisted with coping strategies. Nursing 
      ensured medication adherence, nutrient intake, wound prevention, and incontinence
      management, whereas physiatry addressed abnormal muscle tone. OUTCOMES: Eleven
      months post-admission the patient's progress allowed discharge to a long-term
      care facility. At this time he was without dysphagia or need for a PEG.
      Orthostatic hypotension and bilateral shoulder pain symptoms were also resolved
      while bowel/bladder incontinence and upper and lower extremity motor strength
      loss remained. He was largely independent in transferring from bed to wheelchair 
      and in upper body dressing. Lower body dressing/bathing required maximal
      assistance. Gait with a 2-wheeled walker was possible up to 150 feet with verbal 
      cues and occasional stabilizing assistance. LESSONS: Several specialties
      functioning within an interdisciplinary team fulfilled complementary roles to
      support rehabilitation for a patient with SCI.
FAU - Vining, Robert D
AU  - Vining RD
AD  - aPalmer Center for Chiropractic Research, Palmer College of Chiropractic,
      Davenport, IA bCrotched Mountain Specialty Hospital, Greenfield NH cEvolution
      Chiropractic, Keene, NH dCheshire Medical Center/Dartmouth Hitchcock Keene, Court
      St, Keene, NH.
FAU - Gosselin, Donna M
AU  - Gosselin DM
FAU - Thurmond, Jeb
AU  - Thurmond J
FAU - Case, Kimberlee
AU  - Case K
FAU - Bruch, Frederick R
AU  - Bruch FR
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - IM
MH  - *Cervical Cord
MH  - Comorbidity
MH  - Fecal Incontinence/etiology
MH  - Humans
MH  - Hypotension, Orthostatic/etiology
MH  - Male
MH  - Middle Aged
MH  - Muscle Strength/physiology
MH  - Shoulder Pain/etiology
MH  - Spinal Cord Injuries/complications/*rehabilitation
MH  - Urinary Incontinence/etiology
PMC - PMC5572013
EDAT- 2017/08/24 06:00
MHDA- 2017/09/13 06:00
CRDT- 2017/08/24 06:00
AID - 10.1097/MD.0000000000007837 [doi]
AID - 00005792-201708250-00028 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Aug;96(34):e7837. doi: 10.1097/MD.0000000000007837.