Authors (including presenting author) :
Chan SCN(1), Koljonen PA(2), Wong AFY(1), Tsang RCC(1), Wong CCK(1)
Affiliation :
(1) Physiotherapy Department, MacLehose Medical Rehabilitation Centre (2) Department of Orthopaedics and Traumatology, Queen Mary Hospital
Introduction :
Tetraplegic patients with high level cervical cord injury commonly suffer from poor respiratory functions with ventilator dependence, lack of mobility, heavy burden of care and poor quality of life. The development of diaphragmatic pacing (DP) and robotic exoskeleton has the great potential to significantly improve the respiratory and mobility functions of tetraplegic patients.
Objectives :
The aim of this presentation was to report the improvements observed in a tetraplegic patient in the following: (1) progression in respiratory functions through inspiratory muscle training with maximum inspiratory pressure with and without DP, perceived level of exertion and duration in spontaneous breathing trials without DP; and (2) progression in physical status measured with manual muscle testing, active standing tolerance, number of steps and walking time with robotic exoskeleton training.
Methodology :
A case study design was adopted with the following physiotherapy interventions provided: (1) Adequate conventional respiratory and musculoskeletal physiotherapy with early involvement of caregiver training; (2) Combination of DP with established respiratory physiotherapy interventions to optimize respiratory conditions; and (3) Combination of DP with robotic exoskeleton training to improve physical functions.
Result & Outcome :
The following milestones of the patient were achieved: (1) Post-DP 7 months: Complete weaning from ventilator with 24-hour DP; (2) Post-DP 10 months: Started to regain spontaneous breathing effort with accessory breathing muscles and gradually able to tolerate spontaneous breathing without DP for more than 1 hour, though there was still no active diaphragm contraction measured with EMG; (3) Post-DP 17-18 months: Complete weaning from mechanical in-exsufflation and suctioning in view of minimal secretions and satisfactory cough effort with DP; (4) Post-DP 27 months: Removal of tracheostomy; (5) Post-DP 17-23 months: Completed 16 sessions of robotic exoskeleton training with improvement in vasomotor function and significant decrease in the use of vasopressors; and reduced level of assistance for active standing and transfer activities. (6) Post-DP 30.5 months: Discharge home after progressive discharge planning and caregivers’ training from our multidisciplinary rehabilitation team. The early implementation of advanced technologies such as DP and robotic exoskeleton training to an appropriately selected tetraplegic patient can result in significant improvements in respiratory and mobility functions, enhanced morale and quality of life. Such improvements can also significantly minimize the burden of care for the caregivers and facilitate progressive discharge home care planning.
