ДИСТАНЦИОННОЕ СОПРОВОЖДЕНИЕ КУРСА МЕДИКО-СОЦИАЛЬНОЙ РЕАБИЛИТАЦИИ ИНВАЛИДА С ТРАВМАТИЧЕСКОЙ БОЛЕЗНЬЮ СПИННОГО МОЗГА: КЛИНИЧЕСКИЙ СЛУЧАЙ

Abstract

Spinal cord injury (SCI) leads to profound physical impairments and psychoemotional disorders. Short durations of inpatient rehabilitation are not sufficient to consolidate motor skills and everyday skills. Psychoemotional disorders are the basis of the decreased adherence to treatment between hospitalizations.
Objective – to show a clinical case of medical and social rehabilitation of a person with SCI in a hospital setting and in the context of remote support between hospitalizations.
Materials and methods. We present a clinical case of medical and social rehabilitation of a person in the late period of SCI who had a conduction impairment below C6 and spastic tetraparesis. Initially: burning neuropathic pain in the lumbar region, pelvic floor, inner thighs when sitting for more than 5 minutes with increasing intensity up to 5-6 points on the visual analogue scale, weakness, spasticity, instability when walking, psychoemotional disorders. In hospital, it was possible to achieve improvement in locomotor and manual functions. No increase in the duration of the pain-free period of sitting, allowing for the performance of daily activities, was achieved; no positive dynamics in psycho-emotional status were noted.
The medical and social rehabilitation course was supplemented by a four-week remote phase, for which a set of physical exercises and psycho-emotional correction techniques were developed. The remote phase supervisor contacted the patient weekly for feedback and consultations.
The final results of the medical and social rehabilitation course, including the remote phase, were assessed upon the patient's readmission to the hospital (after 2.5 months).
Results. By the time of rehospitalization, the duration of pain-free sitting had increased from 5 to 30 minutes, which allowed the patient to perform his priority everyday activities and ride his motorcycle for short periods of time. Decreased spastic tone (according to the Ashworth scale), decreased neuropathic pain and increased rehabilitation potential were all objectively recorded.
Conclusion. Focusing rehabilitation on the patient’s priority activities combined with a continuous remote psychological support provides a high adherence to treatment, prevents regression between hospitalizations and promotes social reintegration in SCI.