Background/ Purpose:
Many individuals with spinal cord injury (SCI) face barriers to complex rehab technology (CRT), such as limited insurance benefits, high financial costs, residential structural limitations, and identifying a rehabilitation team knowledgeable in CRT. The purpose of this case is to describe how consistent access and use of a standing frame, in addition to other various devices, have each contributed to function, health, and wellness for an individual in the years following SCI.
Case Description:
The patient is a 65-year-old male diagnosed with T8 AIS A (complete) paraplegia resulting from a car accident in 2002 after being hit by a drunk driver. Before his SCI, the patient enjoyed being active, playing hockey, and riding motorcycles. Following his accident, he utilizes a wheelchair for mobility, and his past medical history includes a right ankle fracture in 2017, neurogenic bowel/ bladder, and detethering of his spinal cord in 2007. The patient attended inpatient rehab immediately following his injury, where he was introduced to using a standing device. He continued clinical use of a standing device as he transitioned to outpatient therapy immediately following his injury to improve his standing tolerance. The patient feared atrophy and osteoporosis, and his goal was to maintain his pre-injury fitness. As he navigated through the rehab continuum, it became clear that complex rehab technology would be his gateway to returning to his active and independent lifestyle.
This patient received a standing frame 2.5 years post-injury (2004) and reported that he immediately began standing in it nightly. Due to exceptional insurance coverage, this patient has gained access to many different home devices over the 22 years following his injury. In addition to his standing frame, he has most notably acquired an FES lower extremity cycle, bilateral lower extremity KAFOs, an exoskeleton, and a dynamic all-terrain wheelchair that can stand and climb stairs.
Outcomes:
Because of his access to a regular standing program in his home and community environment for the past 20 years, the patient reports improved flexibility of his lower extremities, reduced chronic pain, decreased spasticity severity, and maintenance of bone health. The patient demonstrated maintenance of his T-score on his bone density DXA scan over five years from 2016 to 2021. Although categorized as osteopenia to mild osteoporosis, which is usual for individuals with SCI, his doctors were pleased with the stability of his lower extremity T-score DXA scan results.
Discussion:
Although it is impossible to definitively attribute improved outcomes to any one device because the patient receives multiple concurrent interventions, the patient reports numerous benefits from using his standing frame consistently for 20 years. He reports that prolonged use of his standing frame alleviates his tone, maintains his flexibility, keeps his bowel program consistent, and allows him to exercise in standing. He stated, “The frame is key to my overall health. It is a lifetime habit.”
Various complex rehab technologies each play an important role in the function, health, and wellness of an individual living with SCI in different situations and environments. This client is an example of how access to a standing frame, exoskeleton, FES bike, and power wheelchair have each separately and independently played a role in function and health for this individual. This patient has separate goals with the use of each technology. He reports that his standing frame has consistently afforded him opportunities for various hands-free activities while in a prolonged stance without the assistance of a caregiver, maintenance of muscle tone with the FES bike, dynamic movement, and weight bearing using the exoskeleton when a caregiver is present, and independent access to ADLs and IADLs through his power wheelchair. As clinicians work with individuals with SCI, they can serve as advocates for patients to receive various CRT across the lifespan of an individual’s SCI to meet their changing lifestyle needs.
References:
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- Logan A, Freeman J, Kent B, et al. Standing Practice in Rehabilitation Early after Stroke (SPIRES): a functional standing frame programme (prolonged standing and repeated sit to stand) to improve function and quality of life and reduce neuromuscular impairment in people with severe sub-acute stroke- a protocol for a feasibility randomised controlled trial. Pilot and Feasibility Studies 2018; 4:66.
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- Spinal Cord Injury Centre Physiotherapy Lead Clinicians United Kingdom and Ireland (2013) Clinical guidelines for standing following spinal cord injury.
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