Supporting Cauda Equina Syndrome & Soaring to New Heights

October 16, 2020

Total Health Physio & Allied Health were recently contacted to assist with an NDIS participant with a complex medical history as a result of a work injury that resulted in a debilitating and permanent disability.

The participant’s needs are considerable and Total Health Physio is determined to assist this gentleman to help him achieve meaningful goals and improve his quality of life which has been significantly affected due to his disability.

This was a difficult situation. No matter the extent of the situation, the therapists at Total Health Physio will do their best to ensure individuals feel well-cared for, appreciated and hopefully help them to feel positive in their day-to-day lives.

Reviewing medical history

Six years ago the client was working as support staff at a specialist university when he ruptured a disc in his back.

Female physiotherapist in rehabilitation center reviewing medical files

The person sought Physiotherapy assistance at the time, however, his injury was left undiagnosed and after six months of failed conservative treatment, he required surgical intervention which revealed significant necrosis and infection caused by the ruptured disc and consequently resulting in Cauda Equina Syndrome.

Cauda Equina Syndrome occurs when the nerve roots of the cauda equina are compressed, disrupting motor and sensory function. It is characterised by extreme pain, bladder and bowel incontinence & lower limb weakness.

Physiotherapist working with mature patient in rehabilitation center treating a person with back pain

For this individual, the pain starts at the site of his surgery and radiates along his lower back down to his leg. He describes the pain as so debilitating that it induces nausea, causes insomnia, contributes to ongoing fatigue and is causing severe depression.

Fortunately, there are a lot of positive contributions that can be made. Total Health Physio is always ready to help the disabled community, we genuinely care about the outcomes we achieve for our patients.

Undertaking a functional assessment

Our Occupational Therapist performed a full functional assessment to determine how Total Health Physio could assist him. The assessment included:

  • Mobility (both indoor and outdoor)
  • Balance and falls
  • Capacity to manage transfers (for example from sitting to standing)
  • Capacity to manage steps
  • Cognition and communication
  • Motivation levels and mood
  • Daily routines, including a questionnaire about managing ADLs

The Occupational Therapist then carried out a home modification assessment to identify any assistive technology or modifications that would make home life easier for him.

An OT is a wonderful healthcare service for people to start receiving the supports they require and start their journey to good-health to allow them to live a more independent and meaningful life.

Setting wonderful goals

The client identified a number of personal goals:

  • To attain mobility and safety in the home and the community
  • To improve his physical health and mental wellbeing
  • To relieve some pressure on his partner so that they can have some quality time together
  • To engage in further study such a postgraduate degree in a field relating to disability or psychology
  • To provide appropriate therapy interventions to support improved mental health
  • To provide a safe environment in his home to manage self-care tasks (such as showering, grooming, toileting) independently

These are wonderful goals and Total Health Physio is proud to be part of his journey.

Glassed wall Australian living room with amazing views of bush treetops

Occupational Therapy recommendations

The client lives in a two-storey house, so consideration needs to be given to the staircase. Initial recommendations from the Occupational Therapist include:

  • A staircase solution either in the form of a chairlift or a traditional lift to alleviate pain and exhaustion from navigating stairs (we will engage an appropriate builder for an onsite assessment and to obtain quotes for the modification)
  • Engaging a Physiotherapist and Exercise Physiologist to assist with increasing mobility and managing pain
  • Engaging a Psychologist to manage depression, mood and anger outbursts
  • An electric orthopaedic mattress to assist with transferring in and out of bed, reducing pain and supporting a better night’s sleep
  • A support worker to assist with domestic duties such as cleaning and washing
  • The purchase and installation of a toilet bidet to assist with managing personal hygiene and dignity
  • Shower modifications and supports including a shower stool & grab rail

This would enable him to engage in a meaningful pursuit and provide a focus for him that is outside of his physical health.

Physiotherapy recommendations

The Physiotherapist recommended regular visits with a view to:

  • Increase endurance
  • Increase upper body muscle strength
  • Increase core strength
  • Assisting in lifestyle changes for weight management

The Physiotherapist recommended the use of a high intensity interferential machine to assist with pain management. The idea is that the interferential machine will assist with pain gate control theory. It assists in disrupting the pain cycle to bring relief from pain. The client will be able to use the machine as frequently as required to assist with managing his pain.

We are proud to help this individual obtain many assets that would improve his day-to-day life, our holistic approach reflects our values of care.

Considerations

The client’s mental health is a significant consideration in this case. He is dealing with considerable pain which has, understandably, caused anger, frustration and depression.

We respect our client’s situations and choices during rehabilitation. At Total Health, we aim to elicit a smile, a laugh, a hug, a step taken, and enthusiasm for our sessions, this is a great place to start from.

Outcomes

While we have carried out the initial assessments and made recommendations, stage four restrictions relating to Covid-19 in Victoria mean that we cannot yet deliver those recommendations. Once restrictions lift, we will proceed with getting a builder to undertake staircase modifications, and a trial of a new electronic bed.

We have started in-home Physiotherapy sessions which are a meaningful time for us and our client. We have also started implementing the suggestions from our OT.

We are already working towards many goals (namely, independence at home) with many more to go, giving us both a purpose and a positive reason to give our best everyday.

If you know someone that needs to experience our values of Trust, Compassion & Care, please feel free to contact us.