Pain

My patient was a 25 year old involved in single vehicle MVA high speed rollover as a restrained front seat passenger at the end of July. He received extensive head and facial injuries including enucleated R eye, base of skull and cranial vault #, multiple facial #, sub dural and sub arachnoid haemorrhage with associated oedema and craniectomy , large degloving injuring of R face, 3mm anterior displaced odontoid peg # C2, avulsion # of C1 anterior arch and bilateral undisplaced #'s throught posterior arch C1. over the next 12 weeks he underwent multiple operations including skin graft and was eventually transferred to a rehab ward.
Upon initial assessment he required 3x max A for supine to sit, sit to supine, STS and 4 x max A to ambulate ~4m. He was displaying very strong pusher tendencies.He had chedoke McMaster grade 4 for foot, arm, leg, and hand and grade 2 for postural control (surprisingly low given his level of voluntary control
In just 4 weeks as the pusher tendencies dampened down he progressed to 1x min assist for ambulation and Independent for supine - sit - supine and STS. While the improved balance can be attributed to the reduction in pushing the other functional tasks rapid improvement was due to a reduction in pain and anxiety about moving the neck. As a result his postural control improved to a grade 5 in just a few weeks.
I was really surprised at how quickly this patient improved in 4 weeks of rehab given the extensive injury and surgery lists. Each patient like this that we see improves our knowledge and skill base for future clients.