| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Was paralysis distinguished from general muscle weakness or complications of other systemic illnesses?
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Was paraplegia or quadriplegia distinguished from paralytic poliomyelitis or paralysis due to a non-polio enterovirus or acute polyneuritis (Guillain-Barre syndrome)?
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Have imaging studies of the entire neuraxis been performed?
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Has individual experienced any complications from permanent paralysis due to prolonged immobility, such as limb deformities, pressure ulcers, deep vein thrombosis, fluctuating blood pressure and body temperature, osteoporosis, respiratory and urinary tract infections, and constipation?
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Has individual experienced any complications from paraplegia, such as urinary and fecal incontinence, respiratory infections (pneumonia, atelectasis), autonomic dysreflexia, urinary tract infections, kidney stones, kidney insufficiency, constipation, decubitus or pressure ulcers, osteoporosis, and chronic severe pain and spasm?
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Has hereditary spastic paraplegia been considered if there is evidence of other conditions of the nervous system such as optic neuropathy, retinopathy, dementia, ataxia, ichthyosis, mental retardation, peripheral neuropathy or deafness?
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Has the individual experienced any complications from quadriplegia, such as urinary and fecal incontinence, respiratory infections (pneumonia, atelectasis), autonomic dysreflexia, urinary tract infections, kidney stones, kidney insufficiency, constipation, decubitus or pressure sores, osteoporosis, and chronic severe pain and spasm?
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Were other pre-existing illnesses (obesity, diabetes, diabetic neuropathy, and degenerative diseases of the nervous system, coronary artery disease, COPD) identified and treated?
Regarding treatment:
- If there is a tumor involving or causing pressure on the spinal cord, are surgery, chemotherapy, and/or radiation indicated?
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Have infections been treated with antibiotics?
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Has culture and sensitivity been performed to determine the most effective antibiotic therapy?
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Have antibiotic-resistant organisms been identified or ruled out?
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Did individual receive prompt, appropriate treatment?
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Has there been sufficient rehabilitation, such as physical therapy, for individual?
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Has individual experienced pressure ulcers, blood clots, urinary tract infections, and/or constipation as a result of immobility?
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Were thrombolytic agents administered as appropriate? Was treatment effective in relieving thrombosis?
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Were other pre-existing illnesses (obesity, diabetes, diabetic neuropathy, and degenerative diseases of the nervous system) identified and treated?
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Has cardiovascular risk been monitored with cholesterol and triglyceride testing?
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Would individual benefit from psychological evaluation and counseling?
Regarding prognosis:
- Does paralysis, paraplegia, or quadriplegia involve a temporary or permanent change in motor, sensory, or autonomic function?
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Is paraplegia acute or chronic? Are underlying diseases or conditions being treated effectively (e.g. diabetes, diabetic neuropathy, or degenerative diseases of the nervous system)?
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Is individual receiving sufficient rehabilitation?
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Is progressive improvement evident, or has it stabilized?
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If more conservative treatment has failed, is individual now a candidate for surgical intervention, such as decompression of the spinal cord or nerve roots and spinal stabilization?
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Is individual enrolled in a comprehensive rehabilitation program?
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Does he or she have access to appropriate orthotic devices?
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Does individual have realistic expectations?
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Would individual benefit from psychological evaluation and counseling?
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