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

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.

Author(s) Disclosures: none