(Kiosk 4) The Successful Rehabilitation of a Man with Acute Traumatic Spinal Cord Injury and Chronic Hip Disarticulation Amputation: A Case Report

Case Diagnosis: C7 AIS A spinal cord injury (SCI) with prior left hip disarticulation

Case Description or Program Description: A 38-year-old man with prior traumatic left hip disarticulation in 2007 previously ambulating with crutches and independent in his activities was admitted to an inpatient rehabilitation facility (IRF) with a C7 AIS A SCI as a result of being struck by a motor vehicle while bicycling. At the time of admission, he required maximal assistance with bed mobility and was dependent for transfers and wheelchair locomotion.

Setting: Freestanding IRF

Assessment/Results: He received intensive inpatient rehabilitation, including physical and occupational therapy as well as rehabilitation psychology services. He underwent evaluation for a custom wheelchair to achieve optimal seating and positioning. Although his rehabilitation was complicated by episodes of autonomic dysreflexia, a stage 2 sacral pressure injury, spasticity, and orthostatic hypotension, he progressed well and was discharged home with assist from family. At the time of his discharge, he was able to transfer from bed to chair with a sliding board with minimal assistance and propel a manual wheelchair 150 feet with supervision. He, however, continued to require moderate assistance to sit from a side-lying position due to his altered center of gravity.

Discussion (relevance): To our knowledge, no prior case of previous limb loss in SCI rehabilitation has been reported. Sequelae of hip disarticulation amputations, including altered center of gravity, and changes in skin pressure distribution, may pose unique challenges during a patient’s course of inpatient rehabilitation following SCI.

Conclusions: Limb loss may impact one's rehabilitation following SCI, particularly with regards to bed mobility, wheelchair seating and positioning, and increased risk of pressure injury. Nevertheless, good functional outcomes are possible for patients with these dual diagnoses when they receive intensive, coordinated, multidisciplinary care led by a physiatrist with expertise in both SCI and limb loss rehabilitation.