Serving the Underserved: Chronic, Non-Progressive Neurologic Care at an Interdisciplinary University Based Pro-Bono Clinic – A Case Series

Abstract

Research Objectives: To investigate the potential of individuals with chronic neurologic conditions to improve in function and self efficacy. Design: Interdisciplinary clinical faculty and students (physical therapy, occupational therapy, and nursing) collaborated in the assessment and treatment of individuals with chronic, non-progressive neurologic diagnosis. Care was provided with a focus on functional outcomes tracked via comprehensive standardized tests and measures. Setting: University based pro-bono clinic. Participants: Subject diagnosis were chronic in nature, and presented from 1 to 10 years post diagnosis, and were provide care from 18-60 months in duration. Case 1 (49yo male, hemorrhagic CVA on 7.14.14), Case 2 (46yo male, C5-C6 iSCI, s/p motor vehicle accident on 4.21.07), and Case 3 (36yo female, ischemic CVA on 11.15.19). Interventions: Interdisciplinary interventions were customized for each individual: therapeutic exercise, therapeutic activities, gait training, balance training, and activities of daily living. Sessions were provided by each discipline once a week, over the duration of the clients' care. Case 1 for 48 months, Case 2 for 18 months, and Case 3 for 60 months. Main Outcome Measures: SF-36 (physical and mental health subscores) , gait speed, and ADL/IADL score via OT outcome assessment were performed initially, at 3-6 month follow up, and at current time of research submission. Results: All three individuals demonstrated statistically significant changes in measured outcomes. Additionally, Case 1 improved from moderate assist with all mobility/ADLs at a wheelchair level, to independent without an assistive device; Case 2 improved from minimum assist with all mobility/ADLs to independent; and Case 3 improved from dependent in all mobility and ADLs to minimum assist, ambulation with a bilateral platform walker 500 feet and ADLs with adaptive equipment. Conclusions: Individual contributions from an interdisciplinary care team focused on self-management; client engagement in goal setting; home exercise compliance; education to maximize functional outcomes; and optimized participation. This case series demonstrated the ability of an interdisciplinary clinic to facilitate measurable gains in clients typically denied or discharged from reimbursed care in outpatient rehabilitation facilities.