Case Studies
CASE STUDY 1: BASILAR ARTERY THROMBOSIS
Mr."A"54 year old male, successful businessman in general good health, was suddenly hospitalized 7th June 1994.
Inability to move left side of the body with slurring of speech. No history of giddiness, vomiting or convulsions. Past Medical History: Significant for Hypertension of 5-6 years duration, on irregular treatment regime.
Few hours after admission noticed loss of consciousness with total body
paralysis.Tracheostomy and ventilation support provided in the ICU for two months. Passive Physical Therapy maintenance and nursing with good acute care followed until 20th March 1996.
MRI FINDINGS: on admission revealed an area of gliosis in the left occipital lobe. Basilar Artery thrombosis.
Follow up MRI Findings 29th June 1994 presented a non-heamorrhagic infarct in the pons more on the right.
'CSR'-Cortico-Subcortical Relay evaluation by Dr.N.D.CHHABRIA as late as post cerebral Insult 2 years and 4 months.
Findings :
Trace movement (R) UL, Nil movement (L) UL.
Nil Head Neck and Trunk control.
Presence of Bilateral LL extensor thrust.
No Speech.
And totally dependent activities of daily living.
BYPASS was aimed at Spinal extensor mechanism. Spinal Reflexes were stimulated with standing assisted by ankle strategy lock with the help of boots and posterior steel shank. As the extensor thrust improved trunk reactions were added to integrate Basal Ganglia pathway interactions. Visual cues were a great help.
After intensive stimulation in this direction for 1 year Cerebellar pathways were initiated with knee supports, AFO's and Lumbar-Hip complex fixation with leather loops. Postural reactions improved tremendously. Left Cerebellar pathways were more reactive. Asymmetry was thus established and spastic symmetrical reactions broken. As balance improved VOR Vestibular Ocular Reactions in sitting and standing were intensified. Basal Ganglia improvement was still more rapid.
One has to start somewhere in the CNS (Central Nervous System) and proceed towards the major lesion.
EVERYTHING IS CONNECTED TO EVERYTHING ELSE. DETOUR FOR FUNCTION THEREFORE BECOMES MANDATORY.
MRI 10th February 2000 Reveals consolidation of the infarct.
Infarct consolidated. Improvement noticed in the form of 2man assist ambulation and independent sitting with supervision. Integrated head neck postures and some vocal cord reactions with improved spatial orientation, indicating white matter interaction in the presence of gray matter lesion consolidation.
Since 3 months he has attended regular office in his specialized transport van and post lunch regular therapeutics at the clinic. Status of voluntary movements today, has a good initiation in the (R) UL, somewhat less in the (L) and active knee extension (R) more than (L). The whole attitude of the patient has changed. He is more reactive, alert and responsive, communicative with a strong sense of humor which spreads happiness all round.
ANALYSIS OF PATHWAY DYSFUNCTION AND CORRELATED NEUROANATOMICAL MANAGEMENT IS THE GOAL AND AMBITION OF FUTURE REHABILITATION.
For over two years patient was otherwise passive but the potential existed.
Pathway Coactivation Was the Essential Key.
CASE STUDY 2: REAR ENDED COLLISION WITH LBP
Ms."B" 28 year old female computer analyst presents with a history of rear-ended collision. The jarring effect ended in severe low back pain with burning sensations in the soles of the feet. Conservative treatment did help but left her totally handicapped due to recurrence in pain, giddiness, imbalance, sway in standing, scoliosis and marked abdominal weakness.
We have begun to introduce CSR principles in Manual Medicine also under the
unit "MMCS " - Manual Medicine Cortico Subcortical.
On examination in this direction we were flabbergasted to hear a previous history. Episodes of high-grade fever in childhood and imbalance during growth and development. Thus the history of Semicircular canal irritation and giddiness post accident. The Vestibular pathways were tremendously affected (L) more than (R) The patient preferred broad base gait and this has been consistent during her life. With the VN (Vestibular Nucleus) dysfunction, the patient found it very difficult to restore balance on backward tilt.
We rightly concluded that the nervous system was highly contributory to the orthopedic problems of low back pain, or other Orthopedic conditions not responding to Conservative or Manual Medicine programs alone. Results were satisfactory if the neurological aspect was also tackled. The BYPASS used was posture at the Basal Ganglia level. Postural Rehabilitation and Equilibrium program was initiated.
Within two months the low back pain almost disappeared. The feeling of sway and low back pain, which was otherwise a great concern to the patient, was completely under control. It was not a time factor. It was definitely tackling the cause of Neural Dysfunction resulting in protective reactions and spasms with resultant LBP treated but not pain free.
MMCS will now evaluate more cases of this type and prepare a concise report on this very important aspect of Rehabilitation Medicine.
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