Category: Brain Injury; Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development)
Objective : To assess clinical change and determine interdisciplinary therapeutic strategies to improve speech and functional mobility in a patient with catatonia undergoing Electroconvulsive Therapy (ECT). Catatonia is characterized by an inability to move normally, resulting in speech and gait abnormalities.
Case study. Follow-up sessions occurred 3-4 times per week.
NYU Langone Health, Acute Care Hospital
Participants (or Animals, Specimens, Cadavers) :
32-year-old male with catatonia and history of cerebral anoxia, who underwent 12 treatments of ECT in the inpatient acute care setting. Patient presented with severe impairments in speech, neuromuscular control, and executive functioning.
An interdisciplinary approach was utilized focusing on functional control and goal-oriented training to improve the patient's ability to participate in ADL's. The patient benefited from a low stimulation environment, facilitative and proprioceptive input, and constant motivation. Frequent interdisciplinary reassessments of catatonia occurred to evaluate the success of ECT, which was administered both unilaterally and bilaterally.
Main Outcome Measure(s) : Bush-Francis Catatonia Rating Scale, AM-PAC, NOMS
Results : The patient's progress in both therapies was non-linear throughout the course of treatment. Severity of catatonia improved (16/69 to 7/69 on BFCRS). Qualitatively, the patient demonstrated significant improvement in attention, participation, and communication.
The aforementioned therapeutic interventions led to improved communication, however the patient's independence with functional mobility was inconsistent. It was expected that ECT would minimize the effects of catatonia, however, the patient's ability to transfer and ambulate fluctuated throughout the course of treatment. Further research is needed to determine an effective clinical approach and the need for inpatient management for individuals undergoing ECT.
Katelyn Mascali– Staff Physical Therapist, NYU Langone Health, New York, New York
Stephanie Windler– Clinical Specialist in Physical Therapy, NYU Langone Health, Huntington, New York
Christina Moriarty– Senior Speech Pathologist, NYU Langone Health, NY, New York