Michael F. Case Study

It was the 4th January 2020 when life changed for Michael. He sustained a cervical injury whilst practising his passion and chosen profession, as a Rugby player. After running into another player’s chest during a tackle, he fell to the ground unable to move as result of what would later be diagnosed as a hyperextension injury to the cervical spine with rotation at C3-4 vertebrae.

He was straight away sent to St. Mary’s Hospital in London where his prognosis was still very unclear.

Nevertheless, it was clear from his first weeks that his injury was an incomplete spinal injury, as small victories were being achieved daily but at a very slow pace, unfortunately he did not have access to specialist intensive rehabilitation input to exponentially explore his recovery.

This brought him to the Royal Bucks Hospital in the early days of February to engage in a high intensity rehabilitation program to what we know now would result in a wonderful recovery. Michael arrived at the hospital being pushed around by his wife in a tilt-in-space wheelchair, wearing a neck brace and abdominal binder at all times, severe weakness across all muscles below his neck with his right arm and leg presenting mildly stronger than his left. Michael was also experiencing pain in his shoulders, lower back, and knees, as a result from the immobility of staying in bed associated with several previous injuries sustained during his career. He also had patchy sensation all over his body and his hand function was significantly compromised. The ASIA assessment was performed on admission and Michael was then classified as C4 AIS C incomplete spinal cord injury. All the above limitations resulted in Michael requiring assistance with all activities from setting up food, to grooming, showering, dressing, transferring, positioning, and moving around, as his hands did not allow him to engage in function and to self-propel a wheelchair.

In his first week Michael had already stood up with assistance from 2 people, he was committed to face the challenges ahead. Along this process the team started working in understanding how his potential could be explored to give him the physical and mental foundations to improve his abilities. Within 8 days post admission Michael managed to take his first steps assisted by therapists and walked 10 meters in 92 seconds.

Use of hands was significantly impaired and he could only produce 1Kg of gross grasp power in the dynamometer with his right hand and nothing could be registered on his left. When trying to assess his fine grasp using the 9 Hole Peg Test, he was not able to complete the task with either hand.

So now to the numbers:

Michael’s discharge GAS goals score was 68,7; his SCIM score was 71, from the initial 21 points on admission. His last 10 meters walk test was 5,7 seconds (from the initial 93 seconds with assistance). When reviewing his gross grasp function with a dynameter he could now do 51kg with his right and 16kg with his left. When assessing his fine grasp, he was not only able to perform the 9 Hole Peg Test with both hands, as he completed it in less than 33 seconds.

Michael progressed to a level of functionality and independency that he could focus in doing the things he wants and enjoy time with his family and friends. He has been oriented with exercises, strategies, and activities to perform at home and when accessing the gym at his club to complement and continue his recovery process. The team at the Royal Bucks will facilitate this ongoing progress by having catch ups and orientation from a distance, and regular presential follow up reviews.