Mr. Meier’s medical history extended back quite a number of years, covering a range of health problems, some of which would have implications for his recovery and rehabilitation from his SCI. In 1998, he had suffered from thoracic and abdominal aortic aneurysms which were successfully treated.

His history also included ischemic coronory heart disease and repeated thromboembolic incidents (1942, 1963 and 1998), renal cysts, cox arthrosis (leading to a hip joint prosthesis in 1998) and wrist and shoulder arthrosis. Although none of these medical conditions resulted in a permanent disability at the time they occured, these conditions all had the potential of negatively impacting Mr. Meiers’ recovery.

For example, previous aneurysms, heart disease and thromboembolytic incidents placed him at even greater risk for SCI-associated thromboses. His heart disease would impact his tolerance for exercise that could lead to limits in his rehabilitation. Despite this history, Mr. Meier considered himself quite fit for his age just before his SCI. 

Box 2: Aortic Aneurysm Surgery and SCI

I felt relatively healthy before both the aneurysm and the spinal cord injury. I didn’t have any sense of a problem that would require an operation, so I was quite surprised when it came up. There was no discomfort, I wasn’t disabled. I did get a little tired while working. Of course, I thought this was just my age. - Mr. Meier in 2007 In 2007, Mr. Meier underwent his second aortic aneurysm repair.

Though the procedure likely saved his life, he found himself afflicted with paraplegia as a result of the intervention. His primary diagnosis was classified as ASIA B, sub TH4 (indicating that sensory but not motor function existed below the injury level).

Following the onset of SCI, a number of secondary complications arose in the early post-acute rehabilitation phase. A direct result of the SCI included autonomic dysregulation that caused an impairment of his circulation and bladder, bowel and sexual functions. One week after the procedure, he was further diagnosed with respiratory global insufficiency and a tracheostomy tube was placed to allow for mechanical ventilation as well as a tube to facilitate feeding (known as a PEG tube that passes directly into the stomach).

Whether and to what degree the complications that arose were based on Mr. Meiers’ age is impossible to discern. However, being elderly clearly put him at risk for many of the conditions previously mentioned in addition to the aneurysm itself.

Mr. Meier was medically managed for these complications over the 10 days after the surgery. He was subsequently admitted to a paraplegic center where his rehabilitation would be the focus. At the time, his spinal cord independence measure (SCIM) lay at a low 9 out of 100 points (see Box 1 and Table 2, center column).

Although low, Mr. Meiers’ SCIM score was stable just prior to the start of his rehabilitation, reflecting his significanct degree of dependancy four weeks into the SCI. His respiration continued to be artificially assisted with mechanical ventilation, and feeding could only occur through his PEG tube.

Box 3: The Spinal Cord Independence Measure

Medical management and rehabilitation proceeded steadily over the course of four months. In this time, his respiration improved and he was able to eventually breathe without the help of a respirator. As a consequence of the tracheotomy tube, he had decreased sensibility of his pharynx and larynx that later resulted in aspiration pneumonia. This pneumonia required additional medical interventions and was successfully treated. Unfortunately, he continued to suffer from aspiration due to difficulties in swallowing (known as dysphagia). Five months after the start of Mr. Meier’s rehabilitation, his discharge from the rehabilitation center was planned.

As his feeding tube was removed, he and the health care team agreed that he would remain one month longer before being discharged. During this period, his health care team prepared for his departure from the center employing the Rehab Cycle. At this time, a new Rehab Cycle was started.