Mr. G. Case Study

In late 2017 Mr. G. was travelling as a passenger in a light aircraft. During the process of landing the pilot stalled the aircraft and crash landed in a field. He was air lifted to Leeds General infirmary where he underwent immediate surgery.

His injuries were:

• Anterior C2 fracture
• Left lamina C6 and C7 fracture
• T12-L3 fracture with disruption at the twelfth costal transverse joint
• T7 comminuted vertebral body fracture

• L1 crush fracture with retropulsion and cord injury
• Anterior L4 fracture
• Posterior 4^fr and rib fracture
• Anterior rib fracture
• Stemal fracture

The clinical picture of the above is of a conus Medullaris injury.

Mr. G. was discharged from Hospital at the end of March 2018 4 months after his initial rehabilitation. He self-referred to attend our outpatient department and was seeking further physiotherapy input to elevate his recovery to a higher level; in his words “a full recovery”. Mr.G. is highly motivated, and was determined that he would walk again unaided. He was discharged from hospital with a wheelchair and Zimmer frame.

On his initial assessment he presented with both legs showing substantial weakness and impaired sensation below L3, bilateral foot drop, and bladder and bowel incontinence, which he managed independently. Lower back pain worsened when walking for long periods. Mr. G. was mobilising outdoors using a wheelchair provided by wheelchair services and was only able to walk indoors for short distances using a Zimmer frame. Mr. G. had been provided with off-the-shelf plastic ankle foot orthotics (AFO’s) to manage his foot drop while walking. Nevertheless, he was still mainly relying on his upper body and lower back strength with a severe impact on his posture.

After the initial assessment we discussed with Mr. G. his goals and aspirations and it was recommended for him to start an intensive outpatient physiotherapy programme. This consisted of three days per week, each day comprising of four one-hour treatment sessions, including physiotherapy, and hydrotherapy. These was combined with his working life as he returned to lead the business he had built up from an embryonic stage. This period was focused on leg muscle strengthening programme, his walking pattern, gait, balance re-education, postural management and review of orthosis options to enhance his walking (ankle /foot orthotics (AFO)), as well as walking aids.

Alongside his intensive rehabilitation he was introduced to specialist equipment and gait re-education strategies using Indego exoskeleton and the AlterG anti-gravity treadmill, progressing to cross-trainer and body weight support system. Functional Electrical Stimulation was introduced along with several trials to seek a suitable and safe management for his foot drop, for which he currently owns custom made AFO’s. Mr. G. currently moves under his own steam with a good postural control and walking pattern using two crutches, being able to go shopping, as well as returning to his social activities.

Mr. G. progressed to a current program of three sessions per day, once a week. Working on selective movement and aiming towards the possibility of walking unaided. He has returned in full to his working and personal life, has also resumed his flying habits and he is currently planning to go skiing next winter season 2020 as this has always been one of his favourite sports.