Acute spinal cord injury and infection with multidrug-resistant Acinetobacter calcoaceticus-baumannii complex among returning Operation Iraqi Freedom soldiers: Successful innovations in rehabilitation during isolation.
Concerns about drug-resistant infectious organisms are increasing in rehabilitation facilities. Resulting isolation protocols can potentially challenge the patients' access to medical care, psychological adaptation, mobility, and environmental interaction and therefore hinder the rehabilitation process. We report a systematic, retrospective case review of an active-duty Army sergeant who sustained a C5 American Spinal Cord Injury Association Impairment Scale A spinal cord injury while serving in Operation Iraqi Freedom. The patient's acute rehabilitation was complicated by an Acinetobacter calcoaceticus-baumannii complex infection, in the blood and urine, contracted while in Iraq. Isolation protocols were designed to enable regular hands-on contact for proprioceptive neuromuscular facilitation, transfers, wheelchair fitting, mobility training, and environmental control. After 1 mo of comprehensive acute interdisciplinary rehabilitation, delivered in a single room on the spinal cord injury unit, the patient acquired functional skills comparable with other complete C5 tetraplegics in our unit. If a patient with spinal cord injury must be placed in isolation, it is still feasible to conduct a comprehensive interdisciplinary rehabilitation program while strictly adhering to contact isolation protocols.
Recio
Albert C
AC
International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at Kennedy Krieger, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Bohart
Zachary W
ZW
Havens
Spencer R
SR
Stiens
Steven A
SA
D000151:Acinetobacter Infections / Q000150:complications / Q000517:prevention & control*; D040981:Acinetobacter baumannii; D016954:Acinetobacter calcoaceticus; D000328:Adult; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008889:Military Personnel; D010348:Patient Care Team; D010356:Patient Isolation; D026741:Physical Therapy Modalities; D012047:Rehabilitation Centers; D013119:Spinal Cord Injuries / Q000150:complications / Q000534:rehabilitation*