Acute Physical Therapy’s Role in the Interdisciplinary Management of an Individual with Central Cord Syndrome, Multiple Co-Morbidities, and Barriers to Care

Background: Physical therapy (PT) is central in the rehabilitation of Central Cord Syndrome (CCS), an incomplete spinal cord injury characterized by weakness primarily in the upper extremities. There is limited evidence for the effect of common co-morbidities on functional outcomes of CCS. The purpose of this report is to highlight the influence of co-morbidities on the acute PT management of an individual with CCS. Case Description: A 67 year old male fell down a flight of stairs resulting in CCS which was surgically managed. Initial PT assessment revealed flaccid upper extremities, lower extremity weakness, impaired balance, and maximal assistance required for most mobility tasks. Clinical Impression: Expectations for an individual with this presentation are described. Advanced age and denial from subacute rehabilitation facilities negatively impacted this individual’s prognosis. Intervention: Physical therapy in an acute care hospital targeted balance, strength, positioning, transfers, gait, and endurance. Collaboration with speech-language pathology, neurosurgery, nursing, occupational therapy, social work, and psychiatry optimized his care.  Outcome Measures: Gross strength improved to 2/5 in upper extremities and 4-/5 in lower extremities. However, on the Activity Measure for Post-Acute Care form the patient changed from 10 to 11 out of 24 points, which does not meet the minimal detectable change for basic mobility. Discussion: Barriers to his recovery likely included limited English proficiency, scarce social support, COVID-19, pneumonia, poor nutrition, falls, and uninsured status as an undocumented immigrant. The acute care physical therapist had to collaborate with other disciplines and strongly advocate for the needs of this individual.