1201 - Superimposed Disability and Rehabilitation Inequities: The Need for Early Access to Adaptive Devices

72-year-old male with history of poliomyelitis and hypertension admitted for inpatient rehabilitation following L2–L4 laminectomy and decompression for severe cauda equina compression.

Case Description:

The patient presented with progressive lumbar pain, bilateral lower extremity weakness, and urinary and bowel incontinence concerning for cauda equina compression. He underwent urgent decompression, with a post-operative course notable for traumatic Foley catheter placement and neurogenic bowel and bladder. Prior to hospitalization, despite residual bilateral hand and right leg weakness from childhood polio, he maintained full independence in ADLs and IADLs using a walker, powered wheelchair, and other adaptive equipment. During inpatient rehabilitation, he demonstrated significant decline in independence, requiring assistance for mobility, transfers, and self-care. He participated in three hours of multidisciplinary therapy daily, including physical, occupational, speech, and neuropsychiatric therapy. He repeatedly requested assistive devices to regain upper extremity function; however, these were not covered by insurance. Despite progress, he was unable to return to his pre-hospitalization level of independence.

Discussions:

This case exemplifies the importance of early access to adaptive equipment during rehabilitation for patients with pre-existing or new disability. Inpatient rehabilitation provides a unique opportunity for patients to trial and train with specialized assistive technologies that can restore independence and prevent functional decline. Such devices help empower patients, reduce exclusion, and enhance opportunities in community engagement.1 However, insurance coverage limitations and lack of hospital resources left this patient without essential adaptive tools, potentially prolonging recovery and risking permanent loss of previously preserved function. Advocacy for inclusion of adaptive devices in hospital budgets is needed to ensure equitable rehabilitation and maximal independence.

Conclusions:

For patients with new neurological injury superimposed on pre-existing disability, early access to adaptive equipment during hospitalization is critical. Institutional funding to develop an inventory of adaptive devices can promote equity, hasten recovery, and improve long-term quality of life.