Jean-Luc Banks, MD
Resident Physician
UPMC
Pittsburgh, Pennsylvania, United States
Maria Twichell, MD
Attending Physician
UPMC
Pittsburgh, Pennsylvania, United States
Nicholas Tranchitella, MD
Resident Physician
UPMC
Pittsburgh, Pennsylvania, United States
Functional Neurologic Disorder
A 28-year-old female with a history of traumatic brain injury, cervical atlas injury, and a survivor of domestic violence and sex trafficking presented from a Women’s Shelter for new-onset bilateral lower extremity weakness and inability to stand. She was recently admitted for the same medical issue and discharged with the ability to ambulate 10 feet with a walker. All imaging and workup were unremarkable and she was diagnosed with functional neurologic disorder. Her hospital course was complicated by severe pain unresponsive to narcotic-free multimodal treatment. On admission, she completed static standing balance with max assist of 1-2 for 30-45 seconds, transferred with mod assist, and completed ADLs with mod-max assist. She underwent comprehensive inpatient rehabilitation with a trauma-informed care approach. At discharge, she had progressed to modified independence with transfers and independence with wheelchair mobility. Soon after discharge, she could stand independently and began taking steps with minimal pain.
Our inpatient rehabilitation team developed a trauma-informed care approach to this patient’s stay. We focused on allowing the patient to create her environment of safety and autonomy with minimal interruptions. We aimed to gain and maintain the patient’s trust throughout her stay by communicating and collaborating regarding her plan of care thereby empowering her resilience and promoting self-efficacy.
Trauma-informed care is an interventional and organizational approach that understands that trauma can impact an individual’s life and subsequently their rehabilitation. It is a scalable practice that should be implemented amongst all rehabilitation patients, not just those identified as having a history of trauma or labeled as "difficult" by the medical system. In developing a trauma-informed patient care approach, it is imperative to educate and involve all clinical and nonclinical staff that have any interaction with the patient to ensure congruence of care and treatment throughout the patient's hospitalization.
