From the Research
A 26-year-old paraplegic due to gunshot wound requires comprehensive multidisciplinary follow-up within the first 12 months after injury. The patient should see a physiatrist (rehabilitation specialist) every 1-3 months to coordinate care and monitor overall recovery 1. Regular appointments with a urologist are needed every 3-4 months to manage neurogenic bladder issues, including potential catheterization needs and urinary tract infection prevention. A gastroenterologist should evaluate the patient every 4-6 months for bowel management.
Key Specialist Follow-ups
- Physical therapy sessions should occur 2-3 times weekly initially, then gradually decrease as the patient progresses, focusing on strengthening, range of motion, and transfer skills.
- Occupational therapy is essential for developing adaptive techniques for activities of daily living.
- The patient should see a mental health professional (psychologist or psychiatrist) monthly to address adjustment, potential depression, PTSD, and other psychological impacts.
- Wound care specialists should monitor for pressure injuries every 1-2 months, as paraplegia increases risk for skin breakdown.
- Pain management specialists should be consulted as needed for neuropathic pain, often treated with medications like gabapentin (300-1200mg three times daily) or pregabalin (75-300mg twice daily) 2.
Considerations for Care
- The complexity of spinal cord injuries due to gunshot wounds necessitates a coordinated, interdisciplinary approach, as highlighted in cases of cranio-orbital gunshot wounds 3 and spinal cord injuries without direct injury to the cord 4.
- The management of such extensive injuries can be challenging and requires awareness of the possibility of severe neurologic deficits even without violation of the spinal canal 4.
- Early intervention, such as cervical spine decompression and fusion in cases of Brown-Séquard syndrome, can lead to significant recovery 2.
Ongoing Care and Monitoring
- Regular follow-ups with the aforementioned specialists will help in preventing complications and maximizing functional independence during the critical first year of recovery.
- The patient's care plan should be tailored to their specific needs, taking into account the severity of the injury, the presence of any associated injuries, and the patient's overall health status 5.