The rehabilitative management of the traumatic brain injury patient with associated femoral neuropathy.
The initial diagnoses of associated injuries in patients with traumatic brain injury (TBI) are often overlooked because of the priority given to life-sustaining measures. Pelvic and abdominal injuries comprise less than 5% each of the concurrent injuries associated with TBI and multiple trauma. This report describes a 32-year-old man who sustained a moderate TBI with facial, pelvic, and extremity fractures secondary to a fall. His hospital course was complicated by sepsis, acute renal failure, and retroperitoneal hemorrhage. Admitted to the rehabilitation service 6 weeks after the fall, the patient was found to have a previously undiagnosed profound quadriceps muscle weakness. A diagnosis of femoral neuropathy was confirmed by electrodiagnostic studies and was attributed to compression by pelvic hematomas. Rehabilitation management included use of a solid ankle cushion heel (SACH) wedge, a functional knee brace, a progressive ambulation program, neuromuscular stimulation, and patient and family education with an emphasis on safety. The patient progressed rapidly with his rehabilitation program, improving from moderate assistance in all skills to independence in 3 weeks. This case illustrates the importance of the physiatrist's role in the early detection of associated injuries in patients with multiple trauma and TBI; it also illustrates some of the rehabilitation techniques that may be employed to aid a patient with a femoral neuropathy to regain junctional ability.
Groah
S L
SL
Department of Physical Medicine and Rehabilitation, Medical College of Virginia, Richmond 23298-0661, USA.
Cifu
D X
DX
D000328:Adult; D001930:Brain Injuries / Q000150:complications* / Q000534:rehabilitation*; D005267:Femoral Nerve; D006801:Humans; D008297:Male; D009104:Multiple Trauma / Q000534:rehabilitation; D010523:Peripheral Nervous System Diseases / Q000150:complications* / Q000534:rehabilitation