Brian Abarbanel, MD
Resident Physician
McGaw Northwestern Shirley Ryan AbilityLab
Chicago, Illinois, United States
Leslie Rydberg, MD
Associate Professor, Clerkship Director, Associate Residency Program Director
Shirley Ryan AbilityLab and Northwestern University Feinberg School of Medicine
Chicago, Illinois, United States
67-year-old male with legal blindness and osteogenesis imperfecta with multiple fractures who had acute onset lower extremity weakness after routine right foot tendon lengthening surgery, found to have a T8-9 extramedullary mass causing severe spinal stenosis and myelopathy, now status post tumor resection. He remained non-weight bearing in the right lower extremity and presented to inpatient rehabilitation (IPR) with lower extremity weakness.
Case Description:
After his surgeries, the patient was required to wear a controlled ankle motion (CAM) boot in his right lower extremity and to avoid bending/lifting/twisting activities. Despite extensive work with PT and OT, the patient was unable to don and doff his CAM boot without assistance due to his visual deficits and inability to bend/twist. The orthotics team, PT, and physician team worked together to troubleshoot and create a series of custom straps for the CAM boot to make it possible for the patient to manage his CAM boot independently. The straps featured large handles on brightly colored hook and loop fastening strips, oriented horizontally across the boot.
Discussions: The challenges presented to the patient from his new lower extremity weakness were compounded by his extensive comorbidities. In this example, the patient was unable to adhere to his orthopedic precautions simply because he could not manage his CAM boot independently. Instead of relying on the standard hardware, the rehabilitation team was able to create a custom solution for the patient, which allowed the patient to more easily manage his CAM boot, increasing his functional independence.
Conclusions: Patients with complex needs and comorbidities in the rehabilitation setting often require innovative care. Our case highlights the unexpected difficulties that can arise for these patients and an example of the customized solutions that the rehabilitation team can provide to help patients maintain their independence.
