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  4. Progression to ambulation following lower limb fractures in an individual with a spinal cord injury: a case report

Progression to ambulation following lower limb fractures in an individual with a spinal cord injury: a case report

Spinal Cord Series and Cases, 2019 · DOI: 10.1038/s41394-019-0171-2 · Published: May 28, 2019

Spinal Cord InjuryRehabilitationMusculoskeletal Medicine

Simple Explanation

This case report presents a rehabilitation strategy for a 16-year-old girl with a spinal cord injury and bilateral ankle fractures, who could not undergo conventional rehabilitation due to her fractures. The patient had an L1 burst fracture in conjunction with bilateral ankle fractures. An alternative strategy called “K-ing” (Kneel Standing/Kneel Walking) was used to facilitate truncal activation without loading the ankle joints. This technique helped the patient achieve upright posture stability without affecting the recovery of her ankle injuries. The “K-ing” strategy can be a useful and simple alternative when ankle injuries are present. It can also help avoid complications associated with bedrest caused by delays in starting ambulation.

Study Duration
Not specified
Participants
A 16-year-old girl
Evidence Level
Level 4; Case Report

Key Findings

  • 1
    The “K-ing” strategy (kneel standing/kneel walking) facilitated truncal activation without loading the ankle joints, which allowed for upright posture stability.
  • 2
    The patient showed partial return of sensation from T10 to S1 on the right and from T10 to S3 on the left at 3 months post injury.
  • 3
    The patient's walking index for spinal cord injury was 7 (ambulates with two crutches, with braces and physical assistance of one person, 10 meters) at the end of 4 months.

Research Summary

This case report describes the successful use of the “K-ing” strategy in a 16-year-old girl with a spinal cord injury and bilateral ankle fractures. The strategy allowed for early mobilization and postural orientation without loading the fractured lower limbs. The “K-ing” strategy simulated standing and walking, which had a positive effect on improving motor function. Loading the hip joint is a critical stimulus in the process of re-innervation of muscles concerned with locomotor training. Introducing this alternative strategy in early mobilization to an upright position may have reduced the length of stay and therefore the cost of hospitalization.

Practical Implications

Alternative Rehabilitation Strategy

The “K-ing” strategy provides a safe and effective alternative for early mobilization and postural orientation in SCI patients with lower limb fractures, allowing rehabilitation to progress without compromising fracture healing.

Reduced Complications

By facilitating early mobilization, the “K-ing” strategy can help prevent complications associated with prolonged bed rest, such as postural hypotension and muscle deconditioning.

Improved Motor Function

The kneel standing and kneel walking components of the “K-ing” strategy can enhance motor function and promote neural activation, contributing to better ambulation outcomes.

Study Limitations

  • 1
    Single case report limits generalizability.
  • 2
    Lack of a control group.
  • 3
    Further studies are needed to validate the effectiveness of the “K-ing” strategy compared to other interventions.

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