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Improved walking capacity after complementary ankle-foot surgery and gait training in a person with an incomplete tetraplegia; a case report

Spinal Cord Series and Cases volume 9, Article number: 22 (2023) Cite this article

Subjects

Abstract

Introduction

The population of people with a spinal cord injury (SCI) is changing to a diverse population with an increasing number of incomplete lesions. Often, these individuals have the capacity to walk, but experience disabling gait impairments.

Case presentation

The course of a 34-year-old male with a chronic incomplete traumatic cervical SCI who initially could walk no more than a few steps with supervision or a wheeled walker is described. He participated in a clinical trial with Targeted Epidural Spinal Stimulation (TESS). After this trial, he was able to walk with a wheeled walker and bilateral orthosis over a distance of 100 meters. Despite these improvements, his main complaints were (1) difficulty to correctly preposition the feet, and (2) pain in his toe and calf muscles. An interdisciplinary approach and the use of structured gait analysis formed the basis for shared decision-making with the team and the patient to perform ankle-foot surgery followed by 2-month gait training with a body weight support system. After this trajectory his walking distance increased to 250 meters, with a wheeled walker; but now without orthosis and with an increased walking speed compared to pre-surgery. Additionally, there was reduction of pain and he experienced no disturbances during sleeping, washing and clothing anymore.

Discussion

This case shows that surgical interventions can improve the gait capacity even in case of chronic incomplete SCI. Furthermore, training with a body weight support system after medical-technical interventions is useful to utilize the full potential of these interventions.

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Data availability

The data of this study can be found within the published article and its Supplementary files. I additional data are needed, they are available from the corresponding author on reasonable request.

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Acknowledgements

We thank our patient for his permission to publish his case and for the inspiration he gives us every day to further improve his walking capacity. We also thank prof. dr. A.C.H. Geurts, physiatrist, for his contribution and advice in the first part of this case. And we thank Lise Wilders for her help in the conversion of the video files.

Author information

Authors and Affiliations

  1. Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands

    Ilse J. W. van Nes, Hennie Rijken & Jorik Nonnekes

  2. Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands

    Ilse J. W. van Nes, Noël L. W. Keijsers & Jorik Nonnekes

  3. Department of Research and Innovation, Sint Maartenskliniek, Nijmegen, The Netherlands

    Hennie Rijken & Noël L. W. Keijsers

  4. Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands

    Jan Willem Louwerens

Authors
  1. Ilse J. W. van Nes
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  2. Hennie Rijken
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  3. Noël L. W. Keijsers
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  4. Jan Willem Louwerens
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  5. Jorik Nonnekes
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Contributions

IN was the responsible rehabilitation physician of the patient, writing the article, updating the reference list and creating the tables. HR was the responsible physical therapist of the patient, was responsible for the gait training and provided feedback on the report. NK was the senior researcher involved in the study, helped with writing the report and creating the tables. JL was the responsible orthopedic surgeon, interpreted the results from the gait analysis, made a treatment plan and provided feedback on the report. JN was the responsible rehabilitation physician of the gait analysis, interpreted the results from the gait analysis, made a treatment plan and provided feedback on the report

Corresponding author

Correspondence to Ilse J. W. van Nes.

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The authors declare no competing interests.

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van Nes, I.J.W., Rijken, H., Keijsers, N.L.W. et al. Improved walking capacity after complementary ankle-foot surgery and gait training in a person with an incomplete tetraplegia; a case report. Spinal Cord Ser Cases 9, 22 (2023). https://doi.org/10.1038/s41394-023-00579-1

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  • DOI: https://doi.org/10.1038/s41394-023-00579-1

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