Promoting functional seated positioning and communication utilising a custom cervical and trunk orthosis in severe traumatic brain injury: a case report

Abstract

Background and Purpose

Published evidence to guide therapists regarding positioning strategies for patients with TBI is limited. This case report describes the development of a custom cervical-thoracic-lumbar orthosis to improve functional seated positioning and communication for an individual with severe traumatic brain injury (TBI).

Case description

A man in his 20 s admitted to an inpatient rehabilitation hospital nine weeks after sustaining a TBI. Upon admission, he presented in a vegetative state with severe positioning and postural impairments.

Intervention

Despite evidence of cognitive progression at 7 weeks post-admission, the patient demonstrated persistent postural deficits and limitations in functional activities and communication. To provide additional postural support, a custom cervico-thoracic-lumbar orthosis was fabricated to promote improved function and communication.

Outcomes

From the time of admission to post-admission weeks 7–8, the patient progressed on multiple measures: Rancho Los Amigos scale: level II to level VII; Coma Recovery Scale Revised 6 points to 15 points; Disability Rating Scale decreased from 25 points to 12 points. Functional Independence Measure 20 points at 6 weeks post-admission to 23 points at 8 weeks post-admission.

Discussion

Custom cervico-thoracic-orthoses may provide additional postural support to promote improved function in individuals post-TBI. Further studies are needed to provide evidence of custom orthoses' effect on function and communication in this population.

IMPLICATIONS FOR REHABILITATION

• To provide evidence of the influence of a custom orthosis on achieving a stable seated posture

• To provide evidence of the influence of a custom orthosis on the functional use of an alternative communication device in the traumatic brain injury population

Keywords:

• Orthosis
• traumatic brain injury
• positioning
• communication
• posture

Acknowledgements

The author thanks the patient for allowing them to publish this case report, Lauren Greenfeld, PT, DPT, NCS for her clinical expertise and guidance which facilitated the concept of a custom orthosis, Neal Counts, CO/LO for his creativity and hard work in developing this custom CTLO, and all of the clinicians and providers on the acquired brain injury unit at Shepherd Center for their support.

Disclosure statement

The author reports no conflict of interest.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.