Multimodal Physiotherapy for Functional Recovery and Pain Reduction in L1 Spinal Cord Injury: A Case Report

Luh Dwi Erna Krismawati; Luh Kadek Asri Junita Dewi Negara

doi:10.24843/mifi.000001854

Authors

Luh Dwi Erna Krismawati Bachelor of Applied Physiotherapy Study Program, Faculty of Health, Universitas Hindu Indonesia, Jl. Sangalangit, Bali 80238, Indonesia Author
Luh Kadek Asri Junita Dewi Negara Bachelor of Applied Physiotherapy Study Program, Faculty of Health, Universitas Hindu Indonesia, Jl. Sangalangit, Bali 80238, Indonesia Author

DOI:

https://doi.org/10.24843/mifi.000001854

Keywords:

Spinal Cord Injury, Rehabilitation, Physiotherapy, Paraplegia, Activities of Daily Living

Abstract

Background: Spinal cord injury (SCI) leads to motor, sensory, and autonomic dysfunction, resulting in long-term disability. Multimodal physiotherapy is a key component of rehabilitation; however, evidence on long-term outcomes in complete SCI at the L1 level remains limited.

Objective: To describe the longitudinal clinical outcomes of multimodal physiotherapy in a patient with traumatic L1 SCI classified as ASIA Impairment Scale (AIS) grade A.

Methods: This study was a case report (n=1) involving a 24-year-old male with traumatic L1 SCI. The patient received multimodal physiotherapy 3–4 sessions per week for 18 months. The program included range of motion exercises, muscle strengthening, balance training, functional mobility training, transcutaneous electrical nerve stimulation, and infrared therapy. Outcomes were assessed using Manual Muscle Testing (MMT), Numeric Rating Scale (NRS), and Barthel Index at baseline and at 1, 3, 6, 12, and 18 months. Absolute changes were calculated descriptively.

Results: After 18 months, proximal muscle strength improved from MMT grade 1 to 4, while distal muscles improved from 0–1 to 3. Pain decreased from NRS 4 to 0–1 (−3 to −4 points), and the Barthel Index increased from 30 to 90 (+60 points). Improvements were most evident within the first 3–6 months, followed by gradual stabilization. The patient progressed from total dependence to assisted ambulation.

Conclusion: Multimodal physiotherapy over 18 months was associated with meaningful improvements in strength, pain, and functional independence. Residual limitations in balance and distal function persisted, indicating partial recovery and the need for continued rehabilitation.