1120 - Value of Staged Admission to Inpatient Rehabilitation In A Patient with Transverse Myelitis

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

SD

Sam Detwiler, MD

Resident Physician
University of Kansas
Westwood, Kansas, United States

Co-Author(s)

VL

Venessa Lee, MD

Attending Physician
University of Kansas Medical Center
Kansas City, Kansas, United States
SF

Stephanie Fortune, DO

Resident Physician
University of Kansas
Kansas City, Kansas, United States
JG

Josh Gassmann, MD

Resident Physician
University of Kansas
Kansas City, Kansas, United States

Submitter(s)

SD

Sam Detwiler, MD

University of Kansas
Westwood, Kansas, United States

Case Diagnosis: Transverse Myelitis

Case Description: A 56-year-old man with transverse myelitis, HIV/AIDS, hepatitis C, and recurrent urinary tract infections presented with chronic sequelae of prior C6–7 discitis/osteomyelitis. He completed an initial inpatient rehabilitation course in 2023 at the time of injury. At spinal cord injury clinic follow-up two years later, he exhibited paraplegia with significant spasticity, poorly controlled neurogenic bowel, neurogenic bladder with recurrent infections, orthostatic hypotension, and a stage I pressure injury. Despite ongoing home-health PT/OT since April 2025, progressive functional decline was observed: increased weakness; new dependence on a Hoyer lift for transfers (previously independent via slide board); maximal assistance for bed mobility and transfers; and total assistance for most ADLs. Given high caregiver burden, complex medical needs, and the need for re-education in bowel, bladder, and skin care, he was referred for a staged inpatient rehabilitation admission.

Discussions: Over a 19-day staged inpatient rehabilitation stay, the patient showed clinically meaningful gains. The team was able to rapidly optimize pain, spasticity and orthostasis regimens with significant symptomatic improvement. Additionally, the team was able to institute a structured bowel program (he had been fully incontinent without a program). Functional status improved from total dependence to partial assistance for slide board transfers. He progressed from complete dependence to partial–moderate assistance for lower-body dressing and toileting. This case underscores the value of outpatient-initiated, time-limited inpatient “tune-up” rehabilitation for medically complex individuals who have lost prior gains, enabling targeted medical management, caregiver training, and intensive therapy within a structured environment.

Conclusions:

Staged inpatient rehabilitation can be an effective strategy for secondary functional decline after an initial rehabilitation course. In selected patients, a brief, goal-directed second admission can deliver necessary medical optimization, caregiver education, and focused therapies that restore prior function and potentially reduce long-term care needs.