CA is a 73 year old gentleman who fell down a set of steps in a tube station on 11th April 2024. He sustained numerous severely comminuted and depressed biparital fractures, a traumatic subdural haematoma, a small subdural haematoma, frontal contusions and features of diffuse axonal injury.
He had a pacemaker inserted on 11th May as they thought that the fall could have resulted from cardiac origin. He stayed at QEF for 12 weeks of therapy, and then was discharged home. He contacted Hobbs South East for a burst of intensive therapy, but has continued to attend clinic as he has continued to make steady progress with the team at Hobbs South East.
In clinic, CA has been seen twice a week, for 1.5 hours in the morning, then a further hour in the afternoon, with a 30 min break for lunch. We have worked on isometric strength, to improve his hip and core strength, then explored different postural sets while gradually building foundational strength.
CA started to stand consistently at the end of 2024, but had a bunion which was very painful, and set him back slightly. This was managed conservatively, with support from the podiatry team and purchasing wider shoes!
CA has started to be able to walk unaided in the last month (Feb-March) and is now able to manage the steps down into the Hydrotherapy pool each week. He is progressing well, and has recently been prescribed new orthotics to help improve his foot clearance bilaterally, as the right is impacted by his TBI and the left was historically the primary side affected by his MS.
CA keeps moving the goalposts, and is now aiming to walk longer distances. His wife would really like him to be able to walk from the car to the shops!
•Longstanding left sided weakness due to MS
•New onset right side weakness due to TBI
•Reduced proximal control in standing
•Reduced ankle range of movement bilaterally into dorsiflexion
•Decreased balance
•Sensory impairment on right lower limb- sensory and proprioceptive
•Mild shoulder pain due to weak rotator cuff and overuse of the right upper limb for transfers
•Foot pain due to bunion on the right foot
•General deconditioning due to prolonged period of decreased mobility since the TBI
•Fatigue- muscle and central
•Low pivot transfer using a sliding board and assistance of one, starting to explore pivot transfers with assistance of one
•Mowlift transfer to access the car with assistance of one person
•Bed transfers with maximal assistance of one person
•Assistance of one for all activities of daily living, and domestic tasks
•Standing with mowlift and assistance of one, left side dominant++, minimal weight through the right side
•Unable to drive, and unable to participate fully in previous hobbies and social activities
•Unable to fulfil previous role as husband and father
•Flickers of activity through the right lower limb
• Physiotherapy: 5 hours of therapy split across 2 days per week – for strengthening, transfer progression, standing work, exploration of potential to walk again, increase of aerobic fitness and endurance). Use of the litegait and treadmill in clinic
• Rehabilitation assistant
• Neurotechnology: Use of the OMEGO and blaze pods
• He also attends Hydrotherapy at Holy Cross, and has physiotherapy and occupational therapy with the NHS teams. Since starting Hydrotherapy in February he has decreased to 2.5 hours of therapy per week on one day
• Bed transfers independently
• Step transfer with a frame independently
• Standing unsupported
• Walk with a 4 wheeled walker up to 20 metres
• Able to manage the steps going in and out of the hydrotherapy pool
• Car transfers independently
CA’s Wife:
“Since coming to Hobbs Rehabilitation at Liss, his movement has improved so much compared to how he was straight after the hospital. This is all thanks to the wonderful physios here, thank you so much!”
