Interdisciplinary, Intensive, Activity-Based Treatment for Intrauterine Spinal Cord Infarct: A Case Report

Abstract

orms of intrauterine or perinatal spinal cord injury (SCI) related to fetal position and birth trauma have been described extensively. [1][2][3][4][5][6][7][8][9][10][11] However, intrauterine spinal cord infarcts (IUSCI) with resulting tetraplegia are extremely rare, 12 and there is minimal evidence describing outcomes in this population, especially functional therapeutic outcomes. [13][14][15][16][17][18] Literature describing IUSCI is mainly limited to early medical intervention as most individuals affected do not survive early infancy. [18][19][20][21] Spinal cord infarcts are rare across the lifespan, accounting for only 0.3% of strokes. 22 Limited knowledge exists regarding long-term outcomes for individuals with spinal cord infarcts. [23][24][25] Regardless of etiology, SCI critically impacts children's musculoskeletal and social development. Therapy focuses on reducing secondar y complications including pressure ulcers, pain, bowel and bladder dysfunction, urinary tract infections (UTIs), contractures, scoliosis, spasticity, and depression. Currently, focus is shifting to include neuromuscular activities below the level of the lesion to capitalize on experience-dependent neuroplasticity. 26 This concept is embodied in activity-based therapies (ABT), which are

Spinal Cord Injury at Birth, Expected Medical and Health Complexity in Chronic Injury Guided Anew by Activity-Based Restorative Therapy: Case Report

“…Neural linkages between respiratory and locomotor systems may also promote activation of trunk muscles within the context of upright stepping during ABLT ( Sunshine et al, 2020 ). The current report and the two publications presenting cases by Felter et al (2019) and Pape (2012) follow children injured as a neonate: two during birth and the current of unknown etiology across time outlining their therapeutic interventions and outcomes. Pape (2012) offers a brief case report using NMES, a form of sensory stimulation intended to modulate the intrinsic excitability of the spinal cord, in a 3-year-old with chronic SCI due to a C2-3 level injury with ventilator dependency due to birth delivery with a mid-forceps rotation.…”

“…Neonatal or birth associated trauma to the spinal cord may result in death ( Abroms et al, 1973 ; Donn and Faix, 1983 ; Young et al, 1983 ; Menticoglou et al, 1995 ; Mills et al, 2001 ; Morgan and Newell, 2001 ; Hedderly et al, 2005 ; Coulter et al, 2007 ) or survival ( Ruge et al, 1988 ; Menticoglou et al, 1995 ; Berck et al, 1998 ; Kobayashi et al, 2006 ). Reports detailing the process of rehabilitation and outcomes when a child is injured so very young are limited ( Pape, 2012 ; Felter et al, 2019 ). While the very low percentage of pediatric-onset SCI (3–5%) relative to the total annual number of individuals with SCI (approximately 10,000) ( Nobunaga et al, 1999 ; Vogel et al, 2004 ; National Spinal Cord Injury Statistical Center, 2020 ), the occurrence of SCI in utero or at birth is even less.…”

Case Report: Capitalizing on Development and Activity-Dependent Plasticity, an Interaction With Pediatric-Onset Spinal Cord Injury

“…Only one other case report has been published to date describing rehabilitation of an infant with an intra-uterine SCI. The child, however, was treated more acutely within the first year following injury with a combination of ABRT and compensation strategies ( 14 ). Pape ( 15 ) also provides a brief description of rehabilitation of an infant with a cervical SCI.…”