Journal of Neurologic Physical Therapy:
CSM ABSTRACTS: Platforms, Thematic Posters, & Posters for CSM 2006: POSTERS
Physical Therapy, MossRehab Hospital, Cheltenham, PA.
Purpose/Hypothesis: Descriptions of severe critical illness polyneuropathy (CIP) and functional recovery are sparse in the literature. This case illustrates the potential for recovery from concomitant TBI and CIP, and reinforces the need for intensive, comprehensive services.
Number of Subjects: Case report of a 54-year-old man who sustained a severe TBI due to a mechanical explosion in close proximity to his face. Patient was admitted to rehab 8 weeks after injury, with no active movement or muscle contractions in his trunk, neck, and three extremities. He was able to open and close his right hand spontaneously. He was unable to communicate, and inconsistently able to perform actions with his right hand upon command. Initial FIM scores were all either 1 or 0 and initial Disability Rating Score (DRS) = 21T, indicating extremely severe disability.
Materials/Methods: Patient's acute inpatient rehabilitation course lasted 37 weeks. On the tenth day of his rehab stay, Pt. had EMG/NCV tests with finding of severe peripheral polyneuropathy affecting lower extremities more than upper extremities, diagnosed as critical illness polyneuropathy. This provided an explanation for his minimal movement throughout and also led to the belief that considerable motor recovery might occur, but might require months to years. A strong social situation allowed planning for discharge to his home, despite the expectation of prolonged severe deficits in movement throughout. Heavy focus was placed on family training for all aspects of care, and optimizing return of strength as the polyneuropathy resolved.
Results: At time of discharge, the patient was able to communicate basic needs mostly consistently, drive a power wheelchair indoors with frequent verbal cues and minimal assistance, and feed himself with minimal assistance. Strength remained 1/5 to 2/5 throughout except his right upper extremity, which achieved up to 4/5 strength. FIM scores ranged from 1 to 4, and DRS score at discharge = 13, indicating severe disability. His wife and hired caregiver were able to assist him with all care, including prescribed exercises, positioning, and standing program. Continued recovery of motor function and strength were anticipated, over a prolonged period. Further results will be presented at 3 month and 6-month follow-up after discharge.
Conclusions: Early detection of critical illness polyneuropathy in this patient helped to guide his course of treatment. An extended inpatient rehabilitation course was required due to his severe TBI, severe CIP, and multiple medical com-plications. This allowed him to be successfully discharged to home and be cared for by his family, while his polyneuropathy continued to resolve.
Clinical Relevance: Limited information is available in the literature regarding recovery from severe critical illness polyneuropathy. More information is needed in order to aid in prognosis and help to guide treatment in patients with severe critical illness polyneuropathy.