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General Rehabilitation

Turning a Double Diagnosis into a Triple: A Challenging Case of Inpatient Rehabilitation after Traumatic TBI, SCI, and Amputation

(Kiosk 1) Turning a Double Diagnosis into a Triple: A Challenging Case of Inpatient Rehabilitation After Traumatic TBI, SCI, and Amputation

Saturday, November 18, 2023
12:00 PM – 1:30 PM CT

    Primary Author(s)

  • Jasmina Solankee, MD

    PM&R Resident
    University of Texas Southwestern Medical School PM&R Program
    Dallas, Texas

    • Co-Author(s)

  • AM

    Amy Mathews, MD

    Assistant Professor
    UT Southwestern
    Dallas, Texas

  • Grace Meehan, Other

    Medical Student
    University of North Texas HSC Fort Worth Texas College of Osteopathic Medicine
    Fort Worth, Texas

Case Diagnosis: Triple Diagnoses of TBI, SCI, & Traumatic Amputation following a Motor Vehicle Collision

Case Description or Program Description: A 52-year-old Spanish speaking male was admitted to inpatient rehabilitation (IPR) after sustaining a severe traumatic brain injury (TBI), T10 motor complete spinal cord injury (SCI), and a traumatic left BKA (below knee amputation) following a motor vehicle collision (MVC).

Setting: The patient was admitted to inpatient rehabilitation (IPR) following his injuries.

Assessment/Results: At discharge, the patient required maximum assistance with most ADLs. As of 3 months from discharge, the patient had not attended any outpatient follow up visits.

Discussion (relevance): The overall incidence of dual diagnosis of SCI and TBI amongst SCI patients is variable in the literature but is thought to be as high as 60%, with 17-24% of patients diagnosed with severe TBI category. Therapeutic challenges have been noted in treating dual diagnoses, including behavioral issues, neuropsychological impairments, and increased barriers to safe discharge. Here, we present a novel case of a patient diagnosed with severe TBI and complete motor SCI as well as a traumatic amputation. The incidence of a triple diagnosis, such as in this case, has not been well documented.

Conclusions: There are known barriers to developing a plan of care for rehabilitation in patients with severe TBI due to cognitive deficits. With the addition of SCI-related management and amputation care, it becomes challenging to effectively achieve functional gains in an inpatient rehabilitation setting and timeline.