Enhancing Functional Recovery through Goal-Oriented Early Rehabilitation in Paraplegia secondary to Non-Hodgkin’s Lymphoma

Dealing with cancer is undoubtedly a challenging journey, and when it affects something as crucial as mobility, the road to recovery can seem daunting. Non-Hodgkin’s Lymphoma, a type of cancer that impacts the immune system, can sometimes originate in the spinal cord thus compressing it and leading to paraplegia – the loss of movement in the legs.

Patient presentation and Rehabilitation: A patient with paraplegia due to spinal cord compression at the D2-D4 level stemming from Non-Hodgkin’s Lymphoma, underwent surgical intervention where the tumor was excised but the weakness was persisted in both the legs. Subsequently, the patient received specialized care in the neuro-physiotherapy department, engaging in a 30-days goal-oriented rehabilitation regimen.

Here are some key principles and strategies that were employed in goal-oriented early rehabilitation:

• Comprehensive Assessment and Goal Setting:
  A thorough initial assessment included physical, neurological, and functional aspects which laid the foundation for personalized rehabilitation goals. Based on this assessment, specific goals were set in collaboration with the patient. These goals included regaining mobility, improving strength and coordination and enhancing activities of daily living.
• Patient and Family Education:
  Patient and the family were educated about the condition, rehabilitation process and strategies to promote independence. This encourages the patient to actively participate in the recovery process.
• Early Mobilization and Precautionary Measures:
  Goal-oriented mobility exercises commenced promptly, supported by the use of a Taylor’s brace during the acute phase to ensure safety. This approach helped preventing potential complications such as muscle atrophy, joint contractures and pressure sores.
• Tailored Strength and Conditioning:
  Customized strength training programs, spanning upper and lower limb muscle groups, integrated progressive resistance exercises to augment muscle strength and functional capacity. The application of electrical current was used for weaker muscles of lower limb. The tilt table utilization, further facilitated weight-bearing activities and proprioceptive training.
• Balance training:
  It plays a crucial role in preventing falls and improving stability. Static and dynamic balance training was incorporated in the protocol which helped improving the functional task activities.
• Individualized Home Exercise Program:
  Patient received personalized home exercise plans to sustain and augment rehabilitation progress beyond formal therapy sessions, promoting continuity and long-term benefits.

Post 30 days of rehabilitation, the patient achieved independent walking with a walker and demonstrated notable improvement in functional measures. Goal oriented rehabilitation for paraplegia patients is a dynamic and individualized process. It is important to note that specific approach to goal oriented early rehabilitation can vary based on the factors like extent of the tumor, pre-existing medical conditions and overall health of the patient. The ultimate aim is to help patients regain as much functional independence as possible and enhance their overall quality of life.

Dr. Sanjiv Kumar
Consultant, MPT, Ph.D FIAP
&
Dr. Himani H. Parulekar
(MPT)
Department of Neuro-Physiotherapy