Authors (including presenting author) :
KY LUK1, SH CHEE1, MH YUEN2, K HUI1, CM CHAN1, FC CHUENG2
Affiliation :
1Physiotherapy Department, Queen Elizabeth Hospital 2 Department of Neurosurgery, Queen Elizabeth Hospital
Introduction :
Transcranial magnetic stimulation (TMS) becomes more promising to facilitate motor and sensory recovery of central nervous system in recent researches. TMS may induce long team potentiation on the corticospinal tract by stimulating the spinal neuron circuit and appears to have positive effect on spinal cord recovery. A case receiving combination of TMS with physiotherapy training has been illustrated in this case study.
Objectives :
To illustrate on how team approach and early incorporate TMS with physiotherapy training enhance motor and functional recovery of patient after spinal surgery.
Methodology :
Physiotherapy Department of Queen Elizabeth Hospital (QEH) commenced TMS service since 2014. In 2019, we further collaborated with Department of Neurosurgery on early rehabilitation using TMS. Several cases had been referred after surgery and we worked as a team to provide the TMS service. Both Neurosurgeon & physiotherapist worked together to formulate and conduct the stimulation plan. Madam A, aged 44, had spinal tumor at thoracic level and underwent surgery for tumor excision. Although early rehabilitation was started at day 1 post-surgery, motor and functional recovery of madam A were slow. She had minimal control over her left lower limb. We provided TMS to madam A at 4-weeks post-surgery. TMS over right M1 cortical region using 5Hz theta burst pattern at 80% of resting motor threshold for 600 numbers of pulses was delivered for total 10 sessions. Each session was followed by intensive physiotherapy training for 1 hour. After 10 sessions of TMS, daily intensive physiotherapy training continued until the patient discharged.
Result & Outcome :
Madam A had significant sensory and motor deficit after surgery. At day 1 post-surgery, her left lower limb was graded 0 and her right lower limb was graded 4 on manual muscle testing (grade 0 means no active muscle action and grade 5 means full muscle strength). At 3-weeks post-surgery, her left hip was graded 1-2 and her left knee and ankle remained grade 0. Functionally, she only managed to stand with frame supported by one assistant. After 10 sessions of TMS and training, her left hip, knee and ankle motor control improved to grade 3+, 3- and 1-2 respectively. Functionally, she managed to walk with frame under supervision. Upon the discharge of Madam A from the 8-weeks hospitalization at QEH, her left hip, knee and ankle were further improved to grade 4-, 3 and 2 respectively, and she managed to walk with quadripod under supervision. Team approach and early incorporate TMS with physiotherapy training may enhance motor and functional recovery of patient after spinal surgery.
