Disclosures: Tomas W. Salazar, MD: Nothing to disclose

Case Description: This patient is a 67-year-old man with T10 ASIA Impairment Scale (AIS) A paraplegia secondary to epidural abscess admitted to acute inpatient rehabilitation. Although he developed paraplegia 7 months earlier, an intensive spinal cord injury rehabilitation program was delayed due to medical complications and concern for ability to tolerate acute rehabilitation. He underwent subacute rehabilitation for 4 months and was discharged home. He was admitted to acute rehabilitation several weeks later to improve his mobility and transfers.

Setting: Acute inpatient rehabilitation hospital

Patient: 67-year-old man with paraplegia secondary to an epidural abscess.

Assessment/Results: During his rehabilitation course, he developed significant spasticity in his legs limiting his mobility and function. He demonstrated flexor spasms and dynamic spasticity in his hamstrings that interfered with his lateral transfers. Oral baclofen was increased, however, he suffered from excessive sedation. Low baseline blood pressure prevented the use of clonidine. Via an educational grant, 200 units of incobotulinum toxin A was obtained and injected into his legs as follows: left biceps femoris, semimembranosus, gracilis, semitendinosus; right semitendinosus, biceps femoris. Functionally, he progressed from two person car transfers to one person maximum assist; for toilet transfers, he improved from maximum assist to moderate assist with drop arm commode. In addition to the functional gains, he symptomatically improved.

Discussion: This patient significantly benefited from receiving incobotulinum toxin injections. These injections typically do not occur in the inpatient setting. Prior to the injections, he was slated for discharge to a subacute rehabilitation facility but after treatment, he had made enough functional gains to be discharged home safely.

Conclusion: This case demonstrates the significant utility of inpatient chemodenervation in spinal cord injury patients. Focal toxin injections should be considered in a comprehensive inpatient spasticity approach, as earlier intervention can lead to disposition changes, patient satisfaction, and significant financial savings.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/focal-toxin-injection-during-inpatient-rehabilitation-facilitated-successful-transition-to-a-community-setting-in-a-spinal-cord-injury-patient-a-case-report/