–   JUNE 2022   –

Eddie (35) 

Traumatic brain injury – minimally conscious 

When we first met Eddie, he had been hospitalised with a severe chest infection and the hospital team were at a loss as to how to stabilise him, as he needed high amounts of oxygen therapy, invasive suctioning through his nose to clear secretions, and was septic. Every time Eddie rolled onto his right side, he would drop his oxygen saturation to catastrophically dangerous levels. The goal was to get Eddie out of hospital as soon as possible, with the least invasive interventions, to reduce his risk of complications, so he could regain his quality of life.

The hospital staff suggested the insertion of a tracheostomy because they couldn’t see any other way to get him stable enough to leave hospital. We held a multidisciplinary team meeting with Eddie’s private Allied Health team and the hospital team, where we advocated for Eddie and suggested alternative, less invasive strategies that could be trialled first, before inserting a tracheostomy, that Eddie was likely to have to live with for the rest of his life. The rest of Eddie’s care team had not considered any of the strategies we suggested. 

The hospital subsequently trialled our strategies, which worked; Eddie didn’t need a tracheostomy and was able to be discharged safely home. He has remained at home safely for 12 months and with regular assessments and tweaking of his care plan, we have managed to get him as healthy and stable as he has been in years.

Prior to us helping, Eddie found it difficult to maintain body oxygenation, or even get out of bed. Carers and family were stressed and exhausted because Eddie was so unstable and they were continually worried he would deteriorate further, with no idea how to help him. After we became involved in Eddie’s care, he started noticing improvements to his condition immediately. We’ve created a clear care plan, so if he gets mildly worse, everyone involved in his care is now empowered, educated and understands exactly how to help him. Eddie is now stable, back to living his life as normal, his oxygen levels are normal and there are no concerns any more about him dropping his oxygen levels. He hasn’t gone back to hospital since he was discharged 12 months ago.

Paulo (76) 

C4 AIS A quadriplegia (spinal cord injury with arms, trunk and legs affected by profound weakness) 

Paulo kept being hospitalised for pneumonia and was scared about contracting COVID while in hospital, so he wanted to be able to remain well at home. Due to low lung volume, he couldn’t speak more than 3 words at a time before needing to take another breath, and his voice volume was really low. This meant that he was struggling to communicate, particularly through lockdowns over the phone or via video call with friends and family, struggling to sit out of bed, and was very breathless.

We did a thorough assessment of his respiratory function and suggested we hire a Cough Assist Manual Inexsufflation Device. We trialled this for 3 months and the improvements included: his forced vital capacity improved from 650mL to 920mL (this is the biggest possible breath in and blow out and is the best measure we can take to quantify respiratory health in spinal cord injury to reliably assess over time); no hospital admissions; and speaking in 6-word sentences, more intelligibly with reliable voice volume. We also organised an inspiratory muscle trainer device to strengthen his intact respiratory muscles, with the goal to further improve respiratory function.

Paulo did end up contracting COVID but due to having the machine at home, it was possible to clear his secretions without needing to go to hospital. Speaking with him and his wife, they believe that having the machine at home likely saved his life because he was able to have early interventions and didn’t get to the point where he needed to be hospitalised. It only took one month for Paulo to start seeing improvements in his condition.

Many people aren’t aware that this kind of treatment exists! Inspiratory muscle training is a very new technique that has only recently been researched and shown to be effective in improving lung function in spinal cord injuries.

Maggie (53) 

C4 AIS C incomplete spinal cord injury, with some movement throughout her arms, trunk and legs but globally weak and on a ventilator 24 hours per day

We began working with Maggie after her discharge from hospital in the middle of COVID lockdown. She had been in hospital for 18 months, where the hospital medical team tried to wean her from the ventilator but she had a catastrophic pneumonia that put her in ICU. Consequently, it was deemed at that time it was unsafe to do any ventilator-free time.

The goals of her physio programme were for Maggie to be able to breathe for short periods if the ventilator accidentally disconnected, with the long-term goal to be able to be off for longer periods during the day (a few hours of rest on the ventilator during the day and on all night). Initially, Maggie could only breathe on her own with no ventilator support for 30 seconds at a time.

What was unusual in this case is that the hospital trusted our team to take Maggie off the ventilator. We are the only people who are approved to do it, as they have absolute trust in our services and skills. This is unprecedented – they have never allowed anyone in the community that isn’t affiliated with, or employed by them, to do this before. 

Maggie noticed an immediate improvement in her condition as soon as we started implementing our physio care programme we created for her, which was unprecedented for the community setting under a private practitioner. We continue to work on the length of time and consistency that Maggie can safely wean, and she is currently able to do 15 minutes.

If you need to refer people in your care to a physiotherapist, we are specialised in MS and neuro-respiratory physio and are here to help. Contact us to book a free 15-minute consultation with our team here at Active Edge Physio. Alternatively, complete the referral form online and we’ll be in touch within 24 hours (on week days) to explore the best way forward.