Category: Spinal Cord Injury; Cancer Rehabilitation; Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development)
Objective : To describe the modification of a physical therapy plan of care for a patient with incomplete spinal cord injury (iSCI) and metastatic lung cancer undergoing adjunctive cancer treatment.
Design : Case Report
Inpatient Rehabilitation Hospital (IPR)
Participants (or Animals, Specimens, Cadavers) :
61-year-woman with small cell lung cancer and T5 iSCI following metastatic epidural tumor resection.
Physical therapy goals were set collaboratively with the patient. Interventions focused on task-specific training of mobility skills using compensatory strategies to maximize independence and improve quality of life. Modifications were made to address cancer-related fatigue, promote energy conservation, and prioritize functional skills for home discharge given anticipated disease progression.
Main Outcome Measure(s) : Functional Independence Measure (FIM), Spinal Cord Independence Measure –III (SCIM-III), and Functional Assessment of Chronic Illness Therapy – Fatigue Subscale (FACIT-F).
Admission FIM and SCIM-III total scores were 52/133 & 31/100 respectively, reflecting the need for moderate to total assist for functional mobility tasks. FACIT-F score was 21/52 indicating significant impact of fatigue on daily activities. IPR length of stay was 31 days. At discharge the patient had 40.6% & 22.5% gains in FIM (106/133) and SCIM (55/100) total scores respectively, indicating marked improvements in independence for functional mobility skills. FACIT-F score improved to 41/52 reflecting reduced daily fatigue level. These gains facilitated discharge home with family support.
Conclusions : Functional outcomes were consistent with expected T5 iSCI outcomes, despite progressive cancer stage and concurrent adjunctive treatment. Physical therapy plan of care required consideration of dual diagnosis, cancer-related fatigue, reduced length of stay, and patient-centered goals. Participation in IPR positively affected quality of life and ability to return home with family.