Monoplegia of right LE: Implications for ambulation.

Hi,

Just wondering if someone could either give me a little advice or point me to a sound resource to help me out with a particular client. I will admit that neurological physiotherapy is not my forte, so I defer to those more capable/experienced than myself.

Patient profile: Forty-year-old male patient suffered a TBI (traumatic brain injury) as a direct result of an assault three years ago. Was in a coma for three months, and underwent intensive physiotherapy at an inpatient facility for monoplegia of his right LE (lower extremity), ataxia, speech and swallowing difficulties and memory-related cognitive problems. Also had three fractured cervical vertebra that were stabilised by pins, still currently in situ. Was previously a very active man involved in football and athletics, who is currently ambulating in a wheelchair. Has currently obtained sponsorship for a racing wheelchair and will begin training in that later in the year for cross-country and athletics competitions.

PMx: Previous history of LBP with mild disc prolapse at L4/5. Past history of right shoulder operation to repair supraspinatus tendon. Past history of clots in monoplegic right LE.

Transfers: All independent to and from wheelchair.

Ambulation: Currently ambulating in a manual wheelchair up to fifteen kilometres per day with little difficulty. Patient was a little vague, but confided that he had previously been trying to ambulate on his own without any aids, but due to falls (secondary to ataxia and lack of muscular control in flaccid limb) has been advised by his case manager to stick to the chair. (Case manager is currently on holiday, and is unavailable for further questioning)

Current problems: Ongoing lumbar back pain which is reducing with a core stability and manual therapy approach. Left shoulder pain indicative of mild supraspinatus dysfunction -- commenced rotator cuff exercises immediately to ensure his means of ambulation is not affected. Desire to ambulate in standing.

So, now that you all have his history, I am hoping to get a bit of help with his progression from wheelchair-ambulant to standing-with-the-aid-of-supports-ambulant. As he was previously another physiotherapist's patient, and then requested to continue his therapy with me at the end of the session, thus I did not have the time to conduct a full assessment of his balance, tone or active muscular control. When I see him next week, I can start from scratch, but I was hoping to hear some opinions or thoughts. He is a very motivated happy-go-lucky guy, so I am sure he will be very compliant and I, in turn, want to be able to maximise his potential. With three limbs that work very well, and one that works not so well, would it be out of the question to get him using 2 x FAC (Forearm crutches) with some type of orthotic device to stabilise (at least) his knee/foot enough for ambulation. I was wondering if anyone could recommend any ideas/products or let me know about any similar patients you have come across.

Cheers,
Quickstart

hello,
can u be more specific about the muscle strength grade on the affected LE there are lots of aids available which can be used .

yeah.. paint me a good picture of what the affected limb looks like-- spastic, flaccid, and MMT test from hip to toes... also, is the non-affected LE "normal"?? and how much ataxia is still present? is it still in the lower extremities?
is this LE "monoplegia" a result of the TBI or somehow more spinal-cord-related...?