Judy Peck, PTA, CBIS
Total Rehab Care at Meritus Medical Center Hagerstown, MD

History
21 year old 6 ft 7 inch tall male athlete who sustained a traumatic spinal cord injury as a passenger in a motor vehicle accident on December 29, 2006. Upon arrival at hospital he complained of inability to move LE’s, tingling and weakness in UE’s.   CT scan showed C6 burst fracture. He underwent C5 posterior lateral fusion C4-C6.   He was transferred to inpatient rehabilitation in Jan 2007 at Magee Rehab Hospital.  He was then transferred to Total Rehab Care at Meritus Medical Center on October 19, 2010 for his outpatient rehab to include OT and PT.  His primary goals were to improve sitting balance, transfers and mobility, and increase independence in all basic ADL’s.

Initial  Presentation
Initial evaluation demonstrated no motor response below level of injury, sensation partially intact. UE strength poor with trace triceps, 3/5 biceps but with limited ROM into elbow extension. Pt required total assist for all self care, transfers and mobility.

Treatment Progression
Patient was seen 3-5x/week  in OT and in PT.  Initial upper extremity treatment focused on improving pain free range of motion and strengthening of intact muscular. PT focused on transfers and mobility, which presented a challenge due to the height of the patient. All  equipment was modified or custom made to fit his almost 7 ft tall stature. The patient progressed from use of a power W/C and max assist for all transfers to propelling himself across level ground in a manual W/C and supervision for board transfers. Improved tricep strength was gained in combination with more functional mobility. Despite other gains, the patient did not regain any further motor recovery below C7. Strong lower extremity muscle spasm were present during all transfers and mobility, which resulted in many secondary complications. Other interventions such as aquatic therapy and acupuncture gave limited relief

Initiation of RT300 for Lower Extremity

At the initiation of the RT300 the client still presented with no voluntary contraction of the lower extremities. He was seen for several sessions of one-on-one training and set up with the RT300. The patient’s mother, who is also his full time caregiver, was trained in set up and helped to transition him to our wellness program. Once discharged from our outpatient services, he was referred into our land wellness program which includes independent use of the RT300. To date, he has used the RT300 for a total of  275 RT300 sessions from 10/1/08 to present.  Electrode placement includes bilateral quads, hams and gluts.

Benefits of daily RT300 FES in SCI
It was noted after just a few sessions on the RT300  Leg System, he felt a reduction in the severity of his lower extremity spasm.  During the initial onset of stim, the patient noted lower extremity spasms such that the RT300 had to be stopped and started often 6 to 7 times before being able to tolerate the stim to create a smooth pattern. Now the patient is able to use the RT300 the entire duration without interruption from muscle spams.  Initial duration was 17 minutes which has steady grown to 60 minutes currently. This patient’s legs are able to produce tremendous power during his spasms but over time he has shown steady gains in power during active RT300 sessions from 4.0 to 17 currently. The RT300 has allowed a once active athlete to feel a sense of competitive edge again, seeing his muscles activate and power the RT300 several miles gives him a feeling of accomplishment.

Conclusion
The patient was not only able to make gains in power and increased resistance from 1.0 to 4.0 over the past 2 years, but he was has been able to demonstrate a steady upward climb with energy expenditure from 1.5k/cal to 14.50k/cal/hour. The patient reports the RT300 helps to reduce his leg spasm, makes him feel strong and reduces his neurgenic pain into his legs as well. After an RT300 session, the patient is able to participate in  a gym weight training program for upper body strengthening. It has been very rewarding to see our SCI patients utilize the RT300 and watch functional gains being made at Total Rehab Care each day.