Complex therapeutical rehabilitation approach in the case of a polytrauma patient with traumatic brain and spinal cord injuries – Case report

Abstract

Abstract The multidisciplinary approach of polytrauma cases including traumatic brain and spinal cord injuries, the survival represents one of the greatest challenges, but the decrease of dysfunction and minimizing the psycho-cognitive sequels are at least as important, regarding the patient’s future quality of life. Material and method Under THEBA Bioethics Commission approval (9181 / 11.04.2018), this paper presents a case of a 28-year-old patient with AIS / Frankel (A) paraplegia after a spinal cord injury SCI T3 level secondary to T4-T5 fracture surgically treated. SCI was associated with moderate traumatic brain injury TBI (subarachnoid haemorrhage), thoraco-abdominal contusion (pneumothorax stg, hepatic trauma) and multiple fractures (sternum and costal, operated), neurogenic bladder and bowel. This condition was due to a car accident, occurred on November 13, 2017. The patient was admitted with a psycho-cognitive status, complete bilateral motor deficit in the lower limbs paraplegia, sensitivity disorders anaesthesia type and sphincter disorders. The patient was clinically, paraclinical and functionally assessed according to the standardized protocols implemented in our clinic through the assessment scales: AIS, FIM, QoL-Quality of Life, Ashworth, Penn, FAC, WISCI II. Results: The patient's evolution was slow but favourable. He benefited of neurosurgical care and had thoracic surgery to extract the osteosynthesis material at the sternum. Meanwhile he learned the technique of intermittent catheterisation. As a result of rehabilitation program the patients finally reached the level of wheelchair locomotion and have completely restored the cognitive function. Conclusion: The multidisciplinary team approach consisting of physicians, kinetotherapist, nurses and auxiliary healthcare personnel was the key of the patient’s survival, eliminated the cognitive dysfunction and reduced as much as possible the locomotor one.