Outpatient Physical Therapy for Transverse Myelitis

If you have been diagnosed with transverse myelitis, then you understand how this condition can affect your overall functional mobility and quality of life. Transverse myelitis can limit the way you walk, move in bed, and move from one chair to another. These functional limitations can have a profound effect on your ability to work and enjoy recreational activities.

Transverse myelitis is an inflammation of the spinal cord that can be caused by an infection or an autoimmune disease that affects the spinal cord. The impairments caused by this disease process are quite variable. The location of the lesion in the spinal cord, the acuity of the disease, and the management of the disease after diagnosis can all have an effect on the impairments seen and the functional mobility limitations that are encountered as a result of transverse myelitis.

Physical therapy for transverse myelitis can occur in many different settings. When you are first diagnosed, you may work with a physical therapist in the hospital. You may also work with a therapist in an acute or sub-acute rehabilitation center, or at home to help you improve your mobility and return to maximal function.

Physical therapy for transverse myelitis may also occur in an outpatient setting.

Finding the Right Outpatient Clinic 

Before starting outpatient physical therapy for transverse myelitis, you may wish to do a bit of research to ensure that you find the right physical therapist for you. Start by locating physical therapists near your home, and phone a few to ensure that they are capable to help you manage your condition. Be sure to ask about prior experiences with other patients with transverse myelitis, and thoroughly explain your current condition and functional limitations. You may also want to ask some general questions about insurance regulations, office policies, and hours of operation.

Outpatient Physical Therapy Evaluation 

Your first visit to an outpatient physical therapist will likely be an initial evaluation and assessment. During this session, your physical therapist will meet with you to discuss your condition and history. He or she will also collect baseline data and measurements to help decide on the best treatment strategy for you.

Common components of the initial evaluation include, but are not limited to:

• History: This component of the evaluation is where you tell your physical therapist about your current condition and how it has progressed since onset. Your past medical history will be discussed, and any other treatments you have had for your condition will be noted. Your current medications may be recorded, so it is a good idea to bring a list of any medicine that you are taking.
• Outcomes Measure: An outcome measurement tool may be used to help set goals and monitor changes in your functional mobility as you attend physical therapy. Common outcomes tools include the 6-Minute Walk Test, the Tinetti Balance Scale, or the Timed Up and Go Test. These tests may be repeated on a regular basis to monitor progress.
• Gait: Gait is an assessment of the way you walk. Your physical therapist will monitor your gait and look for specific clues and patterns in your gait cycle that can help determine the best treatment for you. If you are using an assistive device like a walker, wheelchair, or a cane, he or she can make sure it is sized correctly and that you are using it properly.
• Strength: Your physical therapist will test the strength in your arms and legs to get a baseline measurement of how strength deficits may be affecting your function.
• Range of Motion: Your physical therapist may use a goniometer to measure the range of motion (ROM) around specific joints. The baseline ROM measurements can be used to help determine progress as you attend physical therapy.
• Spasticity: Spasticity is a complex impairment that occurs in the body when a problem like transverse myelitis occurs to the central nervous system. Your physical therapist can measure your overall tone and spasticity to help offer proper treatments for spasticity.
• Flexibility: If you have had a lengthy hospitalization because of transverse myelitis, you may notice a loss of overall muscle flexibility and motion. Your physical therapist can measure your flexibility and can help improve your overall flexibility.
• Balance: A diagnosis of transverse myelitis may affect your overall balance and kinesthetic awareness of your body. Your physical therapist will assess your balance in order to ensure that you are safe when moving around and to help guide treatment for any balance impairments that you may have.

Treatments

After an initial evaluation and assessment, your physical therapist should work with you to develop goals and an appropriate treatment strategy. Specific goals may vary greatly from person to person, but the overall goal of outpatient physical therapy for transverse myelitis is to maximize functional mobility to help you return to your previous lifestyle.

Since the impairments seen with transverse myelitis vary so much, it would be impossible to list a "cookie-cutter" treatment approach or protocol for transverse myelitis. Remember to work closely with your physical therapist to understand the treatment for your specific condition.

Common treatments for transverse myelitis include, but are not limited to:

• Neuromuscular Stimulation: Neuromuscular electrical stimulation (NMES) is a therapeutic modality often used in physical therapy. It is a form of electrical stimulation used to help contract one of your muscles or a group of muscles. If you are suffering from weakness in a specific muscle group as the result of transverse myelitis, your physical therapist may choose to use NMES to help improve the contraction of that muscle group in order to improve your overall function. Remember that NMES is a relatively passive treatment, and your physical therapy sessions should include active exercise and movement whenever possible.
• Exercise: Exercises may be prescribed by your physical therapist to help you improve strength, ROM, and flexibility or reduce spasticity. Specific exercises may be prescribed to help improve your proprioception and balance. Your physical therapist may use exercise equipment such as a BAPS board to help improve balance, and a treadmill, upper body ergometer (UBE), or bike may help improve overall endurance and cardiovascular health.
• Gait Training: If you are having difficulty walking, your physical therapist can work with you on your gait. He or she will make sure you are using the proper assistive device for your condition, and exercises can be performed to help improve your overall gait. An important component of gait, mobility, and walking is the timing of muscle contractions. Your therapist may choose to work with you to improve overall awareness and body control by performing exercises to help improve the speed and timing of muscle contractions.

Discontinuing Outpatient Physical Therapy

A common question many people with transverse myelitis have is, "When should I stop attending skilled physical therapy?"

The answer to this question can be a difficult one since many different variables may affect your personal course of physical therapy for transverse myelitis. You may progress flawlessly through outpatient physical therapy and realize rapid gains in strength, ROM, and overall functional mobility. The outcomes measures and goals that you set when you began physical therapy may be easily attained, and your therapy can be discontinued in the clinic while you work independently at home.

Your condition may be quite severe, and your progression through PT may be slow and require quite a bit of work (and motivation) to achieve your personal goals. Be sure to work closely with your physical therapist and doctor to understand your specific condition and what to expect from physical therapy.

Remember that a diagnosis of transverse myelitis carries with it an overall variable prognosis. Your condition may leave you with mild to severe functional loss. Your physical therapist can work with you to ensure that you are able to achieve your maximal functional mobility, but occasionally physical therapy may be discontinued while you continue to experience functional limitations.

If you have been diagnosed with transverse myelitis, working closely with a physical therapist in an outpatient clinic may help you achieve your mobility goals and help you return to your previous level of function quickly and safely.