Improved Right Upper Extremity Motor Control Following TBI
Neurological Rehabilitation
History
29 year old right hand dominant male who sustained a brain injury during a skydiving accident on July 3, 2010. CT scan initially of the head was negative, but a few hours later patient developed a large left middle cerebral artery infarct resulting in right hemiplegia with aphasia. Other injuries sustained in the accident included fracture of left acetabulum and posterior dislocation of the left hip, compression fracture of T3 and T4 and a left scapular fracture. He had inpatient rehabilitation from July 15 to September 7, 2010. He was admitted to Woodrow Wilson Rehab Center on October 19, 2010 for a program of OT, PT and SLP. His primary goals were to improve gait, right upper extremity function and his speech.
Initial Presentation
Initial evaluation of the right upper extremity demonstrated significant limitations in range of motion. Passive range of motion was limited to 60° of abduction, 90° of flexion, 10° of external rotation and 70° of internal rotation. Range of motion was limited by pain in all end ranges. Patient presented with no active motor control in the right extremity except for a trace contraction of the right upper trapezius.
Treatment Progression
Patient was seen daily in OT and in PT. Initial upper extremity treatment focused on improving pain free range of motion. He received passive range in OT daily. In PT the focus was on gentle joint mobilization and passive range of motion. PT also attempted to introduce the RT300 FES arm system early in his program, but he was unable to tolerate the rotational motion. With continued range of motion and eventual introduction of the standard UBE to allow the patient to facilitate right upper extremity movement in a pain free controlled manner he progressed to a point that he was ready to evaluate the RT300. At the initiation of the RT300 the patient still presented with no voluntary contraction of the deltoid, biceps or triceps and no functional use of the right upper extremity. He was seen for a total of 11 sessions using the RT300 from 11/29/10 to 1/4/11. Electrode placement included the biceps, triceps, anterior deltoid, posterior deltoid and the scapula.
Final Presentation
It was noted after the fourth session on the RT300 Arm System the patient was starting to be able to produce contraction of the right upper extremity musculature particularly in the anterior deltoid and bicep. Patient continued to work on the RT300 and OT worked on upper extremity exercises. Upon discharge he presented with the ability to move his right hand to his mouth. Note that the patient used synergistic patterns to achieve this, however it was a significant improvement over his initial presentation. Patient could use the right upper extremity to stabilize objects to allow his left hand to manipulate the object (i.e. hold his jacket as he used the left hand to zip up the jacket).
Assessment
Patient made excellent gains in right upper extremity motor return during a comprehensive therapy program at Woodrow Wilson Rehab Center which included the use of the RT300 FES arm system.