Defying commonly used statements on patients plateauing after 18 months to two years following a serious injury

Angela was 27 years old when in January 2020 she was involved in a road traffic accident causing her to sustain an incomplete spinal cord injury (C2 ASIA D Tetraplegia). At the time of the accident, Angela was working as an accountant.

This case study, written in March 2023, shares Angela’s rehabilitation journey at STEPS Rehabilitation and her plans for the future. 

Spinal Cord Injury Rehabilitation 

Immediately after her accident, Angela was taken to the Queen Elizabeth Hospital in Birmingham, before being transferred to the North West Spinal Injuries Centre for 9 months. Due to covid restrictions, Angela had a prolonged stay in a nursing home before she was able to search for intensive rehabilitation. This search led her to STEPS Rehabilitation,

Upon arriving at STEPS Rehabilitation in December 2021, Angela presented with: 

·       Core and bilateral upper and lower limb weakness 

·       Required assistance with all aspects of activities of daily living and needed assistance two with transfers such as moving from her bed to a wheelchair. 

·       Spasms 

·       Spasticity 

·       Altered sensation and reduced proprioception 

·       Fatigue 

·       Low mood and frustration at current situation

Rehabilitation Goals

Following initial assessments, short- and long-term goals were developed with Angela, these included goals such as: 

·       Eating and brushing teeth independently 

·       Applying make-up to a high standard 

·       Transfer with minimal assistance 

And in the longer term, goals such as returning to community living and work.  

Personalised Rehabilitation Plan 

The STEPS team created a personalised rehabilitation plan, involving intensive input from across the disciplines in the STEPS rehabilitation team, including, physiotherapy, occupational therapy, hydrotherapy, neurologic music therapy, psychological therapies, Tai Chi group and more. 

The programme also included the use of robotic assistive devices such as the ArmMotus™ M2 pro and the ArmMotus™ EMU, to target upper and lower limb strength along with balance groups, gait, and transfer practice.  

Additional complementary therapies were included, such as acupuncture for muscle tightness and pain, FES sessions for upper limb movement patterns, and massage therapy.  

During her time with STEPS, Angela’s goals evolved and expanded as she realised her capabilities and the possibilities. With the unwavering support of the team, who consistently encouraged and recommended new approaches to therapy, she was able to surpass her initial recovery goals. 

Intensive Rehabilitation All Under One Roof 

One of the greatest benefits of STEPS is that everything is conveniently located under one roof. This includes physiotherapy, occupational therapy, aquatic therapy, balance and upper limb groups, tai chi, Pilates, psychology, and neurologic music therapy, where she started to play the piano again and crucially, practice her precise finger movements.

The variety of treatments available at STEPS allowed us to create a unique combination of therapies and medical treatments best suited to Angela’s needs. Alongside the more traditional therapy sessions, Angela enjoyed participating in group sessions with other clients, as well as the hydrotherapy sessions which allow for full-body movement in the pool.

Group sessions like Tai Chi, Pilates, and Chair Yoga have allowed Angela to connect with other clients and share the experience. These sessions provide a more social atmosphere where clients support and encourage one another, celebrating personal achievements along the way. 

Angela has been a supportive and friendly member of the STEPS Community and is an active member of the peer support groups, spending time with other clients, chatting about life in general, their injuries and the progress they were making at STEPS. 

Angela particularly enjoyed the aquatic-based physiotherapy sessions in the onsite hydrotherapy pool. Upon her initial arrival at STEPS, Angela struggled with walking unassisted. However, with the help of supervision, she was able to enter the pool via the steps and work on her balance, walking, and a variety of gait exercises in a therapeutic and calming environment. 

Rehab Technology 

Angela’s intensive rehabilitation timetable also included regular sessions in the RehabHub, using the ArmMotus™, EMU, AnkleMotus™ M2 pro, WristMotus™ and Exomotus™, as well as using MindMaze VR and FES technologies; MindMotion® GO, MindPod and Intento®.  

The RehabHub offers a range of robotic assistive equipment that focuses on specific body segments. For example, the WristMotus™ aids wrist movement, while the ArmMotus™ M2 Pro and EMU are highly effective in improving upper limb strength. 

Specialist Rehabilitation Physiotherapist, Kostas Falidas worked closely with Angela throughout her stay, he said.

Exoskeleton Assessment

As an assessment centre for exoskeletons, clients such as Angela, who are seeking to improve their lower limb strength, can trial a range of exoskeletons. By utilising the ExoMotus™, Angela can 'walk' under the guidance of a physiotherapist in one of the exoskeleton's three modes: passive, active assistive, and active. 

During these sessions, Angela was supported into the ExoMotus™ which is attached to the walking frame; this is then guided by the physiotherapist. The ExoMotus™ has played a vital role in improving Angela’s gait pattern and lower limb strength.  By lowering the device, Angela was able to achieve heel strike and ‘’feel’’ the floor instead of walking in the air, this is really important for improving sensory feedback and gait re-education.  
 
STEPS Rehabilitation 

Angela has had many milestone moments whilst at STEPS and reflects on one of the most memorable,

Thanks to the dedicated care and attention of the STEPS team, Angela's condition has significantly improved during her stay. While initially struggling with walking and balancing, she can now walk with the aid of a stick or supervision and is able to ascend and descend stairs.

She has regained much of her independence with transfers, being able to roll from supine to prone position, sit up from supine, stand up, lower herself from plinth to floor, and transfer with minimal assistance from floor to her wheelchair.

Clear improvements were made in Angela’s clinical outcome measures during her stay across upper limb, lower limb, and functional activities. For example, her “3 meter timed up and go” measure (time taken to stand from sitting, walk 3m and return 3m to sit in the chair) improved from 2mins 57 seconds on admission to 48 seconds in January 2023.  

Outcomes 

Transition Home 

The discharge process proved to be more challenging than expected. Angela faced numerous obstacles, including sourcing suitable and accessible accommodation, getting it ready for her needs, and recruiting an appropriately trained care team to provide essential support. Her experience highlights the complexity and time-consuming nature of the transition home process. 

A care team was appointed with the help of Birmingham ICB, and Angela was fully involved with the interviewing and selection process.  Angela’s care team attended the STEPS training school, where they were taught about the individualised spinal care that Angela requires. During these sessions, the care team did ‘shadow shifts’ to spend time with Angela, took part in all aspects of her care and got to know her both clinically and personally – giving Angela the confidence and reassurance that they could best support her once home.  

Angela moved into an adapted apartment in Birmingham and looked forward to reintegrating into the community, seeing her friends and family and getting back to life and get back to work. She would also like to do some peer support work with a spinal injuries’ charity. 

The Future 

Angela is continuing with physiotherapy, hydrotherapy, and practicing walking with her stick to maintain her mobility and minimise wheelchair use when at home. Additionally, after being unable to travel home to Canada due to her accident, she hopes to visit home and spend time with her nephews and do some travelling. 

Not only has Angela benefited from her time at STEPS Rehabilitation, she has also offered guidance, support, and organised social events and outings for fellow clients, such as a black tie prom style event with a casino theme! 

Angela's friendly, hardworking, and highly motivated personality is evident in the remarkable progress she has made, which serves as a testament to her dedication and persistence.