To report the progress of a young patient with severe TBI who had not received active rehabilitation for 7 months after injury, who acquired assisted walking through physical therapy intervention.
The patient was a 25-year-old woman. She was diagnosed with TBI due to a traffic accident. She had a Glasgow Coma Scale(GCS) of 3 at the time of injury and was intubated. Although she received physical therapy for half a year after the injury, she was unable to actively participate in rehabilitation due to depression and decreased motivation. 8 months after the injury, the patient was transferred to our hospital, where physical therapy was started. On admission to our hospital, her GCS was E4-V4-M6, her general condition was good,and although her mental state fluctuated, she was motivated to participate in physical therapy. She had motor paralysis and hypertonia in the right lower extremity, Brunnstrom Stages(BRS): UE6-HF6-LE2, knee extension 3 and ankle dorsiflexion 4 on Modified Ashworth Scale(MAS). Her ankle dorsiflexion Range Of Motion(ROM) was 0 degrees, In addition to findings of disuse muscle weakness and what appeared to be a learned disuse, there was also ataxia in the trunk. The patient presented with attention and memory deficits as higher brain dysfunction.For basic motions of daily living, she required severe assistance for wheelchair transfer, and her Functional Ambulation Category (FAC) score was 0, and Functional Independence Measure (FIM) score was 28. Physical therapy was focused on contracture, hypertonia, disuse atrophy, and ataxia.The programs were ROM improvement therapy, electrical stimulation therapy, gait training with a long leg brace, and task-oriented training.
At discharge, her GCS was E4-V5-M6, and she was very motivated to participate in physical therapy. Her BRS improved to UE6-HF6-LE4, and her MAS scores for knee extension and ankle dorsiflexion improved to 1 and 3, respectively. Although the lower extremity muscle weakness persisted, the trunk ataxia disappeared. Higher brain dysfunction remained despite improvement in attention and memory deficits. Basic motions were required supervision, and for ambulation, she required minimal assistance with a cane, FAC score of 2, and FIM score of 74.
Even in patients with severe TBI who have not been walking for an extended period, it may be possible to achieve ambulation through physical therapy intervention tailored to their symptoms.
None, as this is a case report.
Walking
Physical therapy
