What is the appropriate rehabilitation plan for a 47-year-old male with spinal cord compression and infection?

From the Guidelines

The patient should be started on an inpatient rehabilitation program with aggressive 3 hours of occupational therapy (OT) and physical therapy (PT) per day, focusing on improving activities of daily living (ADLs), transfers, and bed mobility, as well as addressing the significant impairment caused by spinal cord compression and infection. This approach is supported by the most recent and highest quality study available, which emphasizes the importance of early intervention and prevention of severe joint contractures and deconditioning in patients with spinal cord injuries or infections 1.

The rehabilitation plan should include:

• Physical therapy focusing on gradual mobility progression, starting with bed mobility exercises and advancing to sitting balance, standing, and gait training as tolerated
• Occupational therapy addressing activities of daily living and upper extremity function
• Pain management using medications like gabapentin or pregabalin for neuropathic pain, along with non-pharmacological approaches such as proper positioning and heat/cold therapy
• Bowel and bladder management programs, potentially including intermittent catheterization and timed voiding schedules
• Psychological support to address adjustment to disability and mood changes

The patient's history of IV drug abuse and recent surgical procedures, including a C5-T5 cervicothoracic decompression and fusion, and a C7, T2 laminectomy for resection of epidural mass infection, should be taken into consideration when developing the rehabilitation plan 1. The goal of the rehabilitation program is to improve the patient's functional abilities, prevent complications, and enhance their overall quality of life. As noted in a recent study, early mobilization with a brace and pain control are priorities in the management of spinal cord injuries or infections, and consultation with a spine surgery and physical medicine and rehabilitation physician should be strongly considered 1.

From the FDA Drug Label

The patient has significant impairment in ADL's, transfers and bed mobility due to spinal cord compression and infection. The appropriate rehabilitation plan for a 47-year-old male with spinal cord compression and infection is:

• Inpatient Rehab for aggressive 3 hours of OT/PT a day
• The goal of the rehabilitation plan is to improve the patient's functional abilities, manage pain, and prevent further complications.
• The patient's rehabilitation plan should be individualized and tailored to his specific needs and goals.
• The plan should include a multidisciplinary team of healthcare professionals, including physical therapists, occupational therapists, and nurses.
• The patient's progress should be closely monitored, and the rehabilitation plan should be adjusted as needed to ensure optimal outcomes. 2 2

From the Research

Rehabilitation Plan

The patient's rehabilitation plan should focus on addressing the significant impairment in ADLs, transfers, and bed mobility due to spinal cord compression and infection.

• The plan should include aggressive 3 hours of OT/PT a day to improve mobility and functional outcomes.
• The patient's history of opioid use and potential for misuse should be considered when developing a pain management plan, as opioid administration may synergistically contribute to the pathology of spinal cord injury and increase the development of pain 3.
• Gabapentin may be considered as a first-line treatment for neuropathic pain, as it has been shown to reduce the intensity and frequency of pain and improve quality of life in patients with spinal cord injury 4.
• However, the potential for misuse of gabapentinoids should be monitored, as the duration of disease and severity of neuropathic pain are associated with misuse 5.
• The patient's medication regimen should be carefully managed to minimize polypharmacy and reduce the risk of adverse interactions, as medication management in spinal cord injury is complex 6.
• The amount of physical and occupational therapy received has been shown to affect patients' function and hospital length of stay, with higher rehabilitation minutes associated with improved functional outcomes and reduced length of stay 7.

Inpatient Rehab Order

The inpatient rehab order for this patient should include:

• Aggressive 3 hours of OT/PT a day to improve mobility and functional outcomes
• Pain management plan that considers the patient's history of opioid use and potential for misuse
• Monitoring for potential misuse of gabapentinoids
• Careful management of medication regimen to minimize polypharmacy and reduce the risk of adverse interactions
• Regular assessment of the patient's functional outcomes and adjustment of the rehabilitation plan as needed to optimize recovery.