KCON/PG/CBR/08

Holistic Physiotherapy Rehabilitation Approach for Pott’s Spine in

Pregnancy: A case report
 INTRODUCTION

• Spinal tuberculosis (Pott’s disease) during pregnancy reported to be rare & can be
associated with destruction of the intervertebral disc & adjacent vertebrae that can
lead to cord compression & thereby paraplegia or quadriplegia.

• This serious complication requires special attention during pregnancy & delivery.
Here we reported a case of term pregnancy with Pott’s paraplegia.

• Back pain is a common complaint during pregnancy, usually during the second
and third trimester in a lumbar or sacroiliac pattern.
AIM AND OBJECTIVES

• The goals of Holistic Physiotherapy rehabilitation are prevention of secondary

complications and maximization of physical functioning for Pott’s Spine in
Pregnancy.
 CASE DESCRIPTION

• A 32 yrs. Old female with G3P1L1A1D0, presented to our institute at 35 Weeks of

gestation with sudden onset, progressive Weakness in bilateral lower limbs. She is
having history of pulmonary tuberculosis in her 2nd trimester. History Of dull aching
backache in her 2nd mid trimester. Her neurological deficit progressed in four days
and she was unable to walk even with support. She had Loss of touch and pain
sensations in both lower limbs But her bladder and bowel functions were intact. On
neurological examination, tone & power were normal in bilateral upper limbs.
• In lower limbs, tone was normal & power in proximal & distal groups of muscle
Was 1/5 & 1/5 respectively on both sides. Pain sensation in bilateral lower limbs
was diminished below T12 spinal level.

OUTCOMES MEASURES
• Numerical pain rating scale (NPRS)
• Functional Independence Measure (FIM)
• Manual muscle testing(MMT)
INTERVENTION

• Patient education chair to bed.)

• Deep Breathing exercise • Kegel exercise

• Positioning-Foot correction with pillow • AROM and PROM exercises

placement in supine lying. • Isometrics exercises
• Stretching of calf, hand (intrinsic muscles) • Sensory Integration.
• Bed mobility- lying to side lying, side lying • Relaxation
to sitting, sitting to wheel chair, wheel

This intervention was given for 5days/week for about 6 weeks which include 3 weeks
inpatient rehab and 3 weeks home based rehab
RESULTS

OUTCOMES Baseline 3 weeks 6 weeks

NPRS 9 on NPRS 6 on NPRS 4 on NPRS

FIM 53% 72% 81%

MMT(lower limb) 1/5 2+/5 3+/5

DISCUSSION

• This case report illustrates the challenges of diagnosing and rehabilitating a

pregnant woman with a Pott's spine due to tuberculosis. This patient showed
improvement in function over the duration of her rehabilitation course. While
admitted for inpatient rehabilitation, the patient was educated on how an Pott's
spine can affect pregnancy. Initial goals were set for independence at her activities
of daily living . As her strength increased, this was adjusted to ambulation with an
assistive device.
• Management of the patient with Pott's spine during pregnancy is a complex and
challenging task in which continuity of care is critical to achieving the
overall goals of rehabilitation. Frequent and open communication among
team members, patient, family and care givers is vital to maintaining an
organized and highly individualized approach to both rehabilitation and
reintegration of the patient into the community
 CONCLUSION

• This study shows that the 3 weeks of institutional based rehab and 3 weeks of
home-based rehab provided beneficial effect on pain and improves the disability
index as well as improves the functional capabilities of person.
THANK YOU