| 제목 |
Trial of Self Clean Intermittent Catheterization(CIC) by C5(B) Tetraplegic Patient : A case report |
| 소속 |
Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea1, Biomedical institute, Chungnam National University, Daejeon, Republic of Korea2, Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Sejong Hospital, Sejong, Republic of Korea3 |
| 저자 |
Sang Ha Cha1*, Chang Won Moon1, Il Young Jung1,3, Kang Hee Cho1,2† |
Introduction
It is difficult for patients with C5(ASIA B) injury to voiding independently and that it is impossible to voiding by clean intermittent catheterization(CIC) on their own. The author experienced the case of a 44 years old female patient with tetraplegia C5(B) who can self-voiding through clean intermittent catheterization.
Case
A 44-year-old female patient had a driver-only traffic accident on March 7, 2019. She was diagnosed with C6-7, dislocation compressive myelopathy, Lt. pubic ramus, transverse acetabular fracture, and performed anterior cervical discectomy and fusion C6-7 with cage insert. At that time, her upper extremities strength was 16 points on the right side and 18 points on the left side, with a total of 34 points.
At the time of the initial evaluation, her finger strength function was rather low. Metacarpophalangeal flexion, proximal interphalangeal joint flexion, and distal interphalangeal joint flexion were rated as poor grade on the right side and good grade on the left side, while finger extension, adduction, abduction and 5th abduction were rated as poor grade on the right side and fair grade on the left side.
She couldn't open the disposable vinyl glove with her own fingers. We encouraged her to wear surgical gloves and taught her how to wear surgical gloves every day during occupational complex therapy hours. In the beginning, it was difficult to wear on her own, but after about two weeks of practice, she was able to wear surgical gloves independently in just one minute and 40 seconds. And we looked at different catheter options that could enable her to catheterize herself, including gripper(special features to facilitate advancing a catheter with use of gross, rather than fine grasp) so that she could easily take out cath because of her poor finger pinch power.
Because the right hand had to hold the disinfectant, it was difficult to spreading labia with the force of the left finger. So, during the functional electrical stimulation (FES) treatment time, FES was applied to the finger flexor digitorum superficialis(FDS) and propundus(FDP) muscle to increase the force of holding the disinfectant with the both hand. At that time we started looking for something else to replace her fingers. Among the adult toys, we found a labia spreader, which played a role in spreading the order of the labia by supporting the vagina. We applied it directly to her, but because it was for the Americans, the size was too large to spread the labia properly. Eventually we concentrated again on strengthening finger abductor muscle, and in conclusion she could use her finger strength to open the labia on her own and do CIC on her own.
Conclusion
We conducted various training so that patient with tetraplegia C5 (B) with a total of 34 motor score of upper extremities could perform CICs on her own. In conclusion, this case has implications that even C5(B) patients can perform self CIC through continuous training. |
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Cervical spine MRI
Coloplast gripper - Courtesy of Coloplast Corp.
Labia spreader
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