TRANSVERSE MYELITIS (TM)

by RUSU DUMITRITA
 Transverse myelitis:
o inflammation of both sides of one section of the spinal cord;
o damages the insulating material covering nerve cell fibers (myelin);
o interrupts the messages that the spinal cord nerves send throughout the
body;
o most people recover at least partially;
o with severe attacks - with major disabilities;
o it is very rare syndrome and in 24 hours the patient develop a lot of
symptoms.
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 What can it cause?

o pain;
o muscles weakness – in arms and legs;
o paralysis;
o sensory problems;
o bladder and bowel dysfunction;
o abnormal sensations.
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 Factors that can cause transverse myelitis:
o infections;
o immune system disorders;
o multiple sclerosis;
o neuromyelitis optica (Devic's disease);
o vaccinations for infectious diseases;
o vascular disorders, etc.
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 Complications:
o stiffness, tightness or painful spasms;
o sexual dysfunction;
o depression or anxiety;
o partial or total paralysis
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 the patient Z.L. 27 years old, 7 years ago, had a simple

flu (temperature, sore throat and clogged nose), but
which was manifested with virus at the spine;
 the cause was a poor immune system and the virus
attacked the spinal cord at the thoracic vertebrae (T5);
 the first sign she felt ill and tired, numbness in the legs
and seldom in the arms, after that the numbness spreaded
through body in time;
 after her visit to the doctor, who brought her to the
knowledge of the problem she will face for a long period
of time, the patient was advised to do physiotherapy.
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 now she is wearing torso-lumbar orthosis as well as for stabilizing

all the leg joints;
 she can’t walk, she use wheelchair;
 pacient has high spasticity of the legs and for that she takes
medicines;
 at home she does exercises with weights for legs and arms, exercises
on automatic bicycle and one day in a week she go to do
physiotherapy
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 Assessment of this type of patient implies:

o Muscles strength test. Together with the physiotherapist
we evaluated the muscles and found that:

body parts assessed muscle strength

upper abdominal muscles 4
down abdominal muscles 0
thoracal extensor 3
lower limbs mucles 0
gastrosoleus muscles 0
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o ROM test: all the angles of the upper limbs are good and have no
limitation in making a move. But lower limbs is bed, because she
can’t do active movements, for that we do passive movements and
she has limitation on the knee flexion.

o Balance test: because she can’t go or crawl we don’t perform

dynamic balance test, but we can evaluate the static balance - she
can’t keep the body in standing position if she doesn’t have support.

 Sensitive test: we did this test with many things that have hot or cold
temperatures, we putting them over the skin of the legs for to
stimulate the proprioceptors. We tried to sting the area with a
slightly sharp object that doesn’t damage the patient's tissue.
Touched a lot of different objects (soft, painful, etc.) and observing
how her segments react even all of these tests.
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 Talking with people around her for to find out more

information about her daily activities and behavior. Through
this we have learned that the patient can do all the daily
activities that are related to their execution with the upper
limbs: EAT, DRINK, COMB, WRITE, etc. But because she
can’t use her legs she can’t makes a bath alone, go to the
toilet, dress herself.

 Symptomatic test: Sometimes she has respiratory distress due

to its effort, this puts her at risk. We can observe how she
breathes when she does the exercises. So is recommended to
perform the assisted exercises of the physical therapist and
perform a series of breathing exercises.

 Another important thing is that fever should only be treated at

very high levels, as it seems to disfavor viral infection.
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 Each therapeutic treatment aims at achieving goals:

o preventing complications secondary to immobilisation;
o improving functional rest;
o insuring correct posture;
o prevention and correction of contractures
o monitoring depressive symptoms that can prevent the
recovery program.
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 The physiotherapy program includes:

o is recommended to do hidrokinetotherapy for 8-12 weeks –
because exercises in water, even passive, allow for better
articular mobility.

o standing posture – 45-90 minutes per day. This exercises is

important for to prevention of secondary osteoporosis, which
may occur over time.

o Other important part of treatment can be occupational

therapy - occupational therapy will offer varied methods, fun
activities, fun to enrich cognitive, physical and motor skills
and enhance self-confidence. With occupational therapy, the
patient will learn to interact with family members and develop
social relationships with others.
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o Performing exercises to increase articulation amplitudes:

- Passive Mobilizations - in all the joints and on all the amplitude
of movement, it runs on paralyzed segments to maintain good blood
circulation, to prevent joint ankylosis, muscle-tendon retractions, to return
vicious positions: example – for hip flexion / extension, knee flexion – for all
of the joints of legs.

o Exercises to increase muscle strength:

- Active Mobilizations – for to increase muscle strength the upper
limbs and trunk, start with extensive active exercises with a stick, a medicinal
ball, etc. Muscle toning is done with isometric and resistance exercises, using
dumbbells, extensors, elastic, etc.
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o Coordination exercises:
- we can perform Frenkel's exercises from the lying
position to improve coordination: hip flexion with knee slides the heel
along the bed. Straightening the hip and knee to return to the initial
position. Repeat is done with the other foot.

o Breathing exercises:
- breathing exercises can produce a relaxation of spasticity,
and respiratory gymnastics is important for education of abdominal-
diaphragmatic replication and facilitates the evacuation of bronchial
secretions through drainage posts if is necessary. Example: set up the
arms with deep inspiration, lowering of arms with expiration.

o Self-care in bed:
- the most important thing is that self-care should be taken
in bed so that the patient can change her position in bed without help.
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o Exercises and postures to reduce spasticity:

- reduce spasticity by stretching the lower limb muscles;
- diminishing spasticity through posture in bed: abduction
with external rotation and slight thigh extension, knee extension, leg
dorsiflexion and finger extension and rotation in the opposite direction
of the shoulders and pelvis.

o The most important thing is good family support and a monthly

psychologist's visit so that the patient does not fall into depression.