Transverse myelitis is a disorder of the spinal cord that may cause a number of impairments that can lead to significant loss of functional mobility. It is defined as an auto-immune inflammatory disorder of the spinal cord, and it typically occurs at one specific level of the spinal cord, although the inflammation may span multiple levels.
There are many causes of transverse myelitis, and it may occur spontaneously or as the result of a more encompassing disease process.
Common causes include, but are not limited to, multiple sclerosis, neuromyelitis optica, lupus, sarcoidosis, Sjogren’s Syndrome, or Lyme disease. When transverse myelitis occurs spontaneously it is called idiopathic transverse myelitis.
Common Symptoms of Transverse Myelitis
There are many symptoms of transverse myelitis, and your specific symptoms may vary depending on which level of the spinal cord is affected by the disease. Remember that the spinal cord is a bundle of nerves that communicates with muscles to cause movement and with the brain to monitor sensory changes. Therefore, symptoms can vary widely in transverse myelitis.
Common symptoms include, but are not limited to:
Rapid, progressive weakness or paralysis in the legs, occasionally progressing to the arms
Numbness or tingling in the legs
Diminished sensation, such as decreased sensitivity to pain or temperature sensation
Spasticity in the legs
Difficulty with coordination
Loss of bladder and bowel control
Upper, mid, or low back pain may accompany these symptoms as well. Typically, the symptoms of transverse myelitis progress rapidly over a course of a few hours or days.
If you are experiencing any of these symptoms, you must go to your doctor or local emergency department immediately for accurate diagnosis and treatment.
Physical Therapy for Transverse Myelitis
If you are diagnosed with transverse myelitis, you may encounter a physical therapist at various points during your treatment for the disease. You may work with a physical therapist in the hospital, at an inpatient rehabilitation center, at home once you leave the hospital, or in an outpatient physical therapy clinic.
The main goals of rehabilitation for transverse myelitis are to restore maximal functional mobility and capabilities. Achievement of this goal often requires the work of many healthcare providers. These include your physical therapist, occupational therapist, speech therapist, physician, nurse, social worker, and perhaps a psychologist. All of these professionals must work together to help you maximize your functional mobility and potential.
Physical Therapy for Transverse Myelitis in the Hospital
If you are in the hospital and diagnosed with transverse myelitis, a physical therapist will likely evaluate your condition and work with you to maximize your functional mobility.
He or she will work with other rehabilitation professionals to help determine an appropriate discharge plan, either to home or to inpatient rehabilitation.
While in the hospital, your physical therapist can help you choose and use an appropriate assistive device for walking, and he or she can help you recover basic functions like moving in bed, transferring from your bed to a chair, and walking up and down stairs, if you are able to do so. Your physical therapist will also develop an exercise program for you to do help improve your strength and overall coordination.
Inpatient Rehabilitation for Transverse Myelitis
If you require more intensive rehabilitation after your acute hospital stay for transverse myelitis, you may be referred to inpatient rehabilitation. There you will work with your physical therapist multiple times per day to continue to improve your functional mobility. Your physical therapist may work jointly with an occupational therapist to improve your mobility while performing specific tasks like dressing, toileting, or eating.
Inpatient rehabilitation can provide you an intensive level of care to help maximize your functional mobility to prepare you to return home safely and quickly.
Home Care Physical Therapy for Transverse Myelitis
Once you are sent home from the hospital or rehabilitation center, you will likely wish to continue with your rehabilitation. If you are unable to leave the house, often a home-care physical therapist will come to your house to work with you.
Your home-care physical therapist can help progress your walking ability and gait, and he or she may work with you to improve your stair climbing ability. If you are not able to walk independently, your physical therapist can help you learn to maneuver a wheelchair and appropriate recommendations can be made for suitable wheelchair for you.
Outpatient Rehabilitation for Transverse Myelitis
Once you are able to leave the house, you may wish to continue your rehabilitation at an outpatient physical therapy clinic. There you will likely have access to exercise equipment to help maximize your strength, balance, flexibility, and functional mobility. Your physical therapist in outpatient PT can devise an appropriate long term exercise routine to help you maximize your overall potential and mobility.
Even with the most rigorous physical therapy and rehabilitation program, the prognosis for transverse myelitis is variable. About 1/3 of people with the diagnosis recover fully, another 1/3 are left with mild to moderate degree of disability, and 1/3 of people with transvers myelitis are left with significant functional loss and disability. Be sure to work closely with your doctor to understand the factors surrounding your specific condition that may have an impact on your prognosis.
If you are diagnosed with transverse myelitis, it is essential that you have a plan of care the can maximize your overall functional mobility. Your physical therapist is one member of your rehabilitation team who can help you reach your full potential.
Rehabilitation in Transverse Myelitis
Carr, J. H. (2000). Neurological rehabilitation: optimizing motor performance. Oxford: Butterworth Heinemann
The Transverse Myelitis Association