Mike Mulligan - Paralysis

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Background Information

Michael Mulligan is a 23-year-old young man who has just completed his engineering degree at UWO. He lives in St. Mary's. His father, Gerry, age 49, is a truck driver and his mother, Brenda, age 44, is a homemaker. He has a brother, Ryan, age 21 and a sister, Jamie Lee, age 17.

June 1996, Michael was on his way home from a party with a buddy at about midnight when he lost control of his car on a gravel road. It is possible that he was drinking at the party, but does not remember the details. No charges were laid. The car flipped over several times and ended up on its roof. His friend sustained only a fractured wrist. Although Michael was wearing restraints, his head hit the roof and he sustained a fracture dislocation involving the 5th and 6th cervical vertebrae. An ambulance was called almost immediately by a passerby, but it took almost an hour to extract him from the car. His neck was stabilized and he was taken to hospital in Stratford where he required intubation to protect h is airway. A urinary catheter was also inserted and he was transferred to London Health Sciences Centre.

Upon arrival at LHSC, his vital signs were stable and he was alert. However, his extremities were completely paralyzed except for partial elevation of his arms at the shoulders. He had no sensation below his shoulders except in the upper outer arms and he completely lost bowel and bladder sensation. He required surgical decompression and stabilization of his cervical spine and he was started on physiotherapy. He developed a sacral ulcer which gradually healed. He was transferred to Parkwood Hospital six weeks after the accident for further rehabilitation.

During his six months at Parkwood Hospital, he received extensive physiotherapy, occupational therapy and bowel and bladder training. By the time he was discharged home in February 1997, he had regained full power in abduction of his arms and had partial recovery of elbow flexion and wrist extension. There was no return of voluntary movement in his legs. He had some neck pain but this resolved. Leg spasms were controlled with a muscle relaxant.

Neurological examination reveals that he has normal power in the deltoids, mild weakness in the biceps and moderate weakness in wrist extension. He has no power in the triceps, finger flexors or extensors or small hand muscles. His legs are spastic and powerless. He has no sensation below the nipple level and only partial sensation between the shoulders and nipples. The biceps deep tendon reflexes are difficult to elicit, but the triceps, knee and ankle jerks are all hyperactive.

Michael's past history was unrevealing. His perinatal history was unremarkable and his milestones were normal. He worked part-time in the local grocery store. His participation in sports was limited to the occasional game of pickup football.

Michael needs an attendant especially in the morning and evening. The attendant transfers him from wheelchair to bed and commode and helps with urinary catheterization. Michael can usually tell when he has a full bladder because this makes him sweaty and sometimes gives him a headache because of increased blood pressure. Within the last year he trained himself to do his own catheterization. He is treated about once a month with an antibiotic for bladder infections. A suppository is inserted into the rectum every other day which usually allows him to moves his bowels although he sometimes requires manual disimpaction.

With his degree completed, he is presently looking for work. during the remainder of high school and into university, Michael maintained a B+ average. His marks actually improved after the accident because he became more focused academically. He has a writing splint which allows him to take notes at school and he has another device which is attached to his index fingers so that he can type. He has another device which is strapped to his right hand which allows him to use a fork and spoon although he cannot use a knife. Michael still lives with his family who have made many adjustments. The family home was initially modified and the stairs were equipped with an electronic lift to enable him get up and down. Subsequently, the family built a 'purpose-built' home to enable Michael live more easily. An insurance company has paid for most of his medical costs although he has also had some support from the Assistant Device Program of the Ministry of Health. He now has a new motorized wheel chair and a specially-equipped van, both of which he paid for himself.

PCL Learning Issues

Disease

Define the terms tetraplegia (quadriplegia) and paraplegia

  • Tetraplegia � paralysis of all 4 limbs
  • quadriplegia � incorrect nomenclature for tetraplegia
  • paraplegia � paralysis of any limbs
  • american spinal injury association (ASIA) � give grading method described

Briefly review your understanding

  • of the degree of paralysis (loss of function) suffered by Michael with those of the well-publicized cases of Christopher Reeve and Canada's 'Man in Motion' Rick Hansen. Are there research findings which offer encouragement to victims of spinal cord injury
  • C5-6 injuries often recover to C4
  • Christopher Reeve had a C2 injury, though he has recovered some function (within 5 years)
  • It was previously thought that if recovery didn't happen in 2 years, it wouldn't happen

Illness

Discuss the daily life and quality of life of persons with spinal cord injuries: home, school, employment, recreation

  • Women had poorer level of wellbeing than men
  • being in a community of other disabled people was associated with poorer level of wellbeing � systematic bias.
    • Life expectancy is increasing as of late
  • How much assistance is required for the three individuals outlined in the previous objective?

Discuss coping with the need for attendant

  • Who usually cares for patients with spinal cord injuries?

Person

Discuss sexual function and fertility for male and female patients with spinal cord injuries. What is possible and impossible?

  • C5 injury and below -> can have erection but not ejaculation (parasympathetic but not sympathetic)

Michael's hopes to marry and father children - is this realistic?

  • Motility of sperm of men with spinal cord injury is inhibited
  • larger percentage of dead sperm
  • source: neurogenic bladder, neurogenic bowel, etc. Physiotherapy journal.

Context

How are costs covered for hospitalization, rehabilitation, attendants, devices?

What is provided by the Assistant Device Program of the MOH?

  • Pays up to 75% of the costs of equipment
  • not included: automobile modifications; batteries; bathroom stuffs; home renovations
  • What resources are available for families?

Resources

  • [Domain-specific satisfaction in adults with pediatric-onset spinal cord injuries]
  • the [ASIA scale]