Short answer: An older man with a severe spinal cord injury (ASIA Impairment Scale B) and multiple other injuries after being struck by a vehicle moved safely from hospital to home. His occupational therapist coordinated equipment, bedroom and bathroom modifications, home care, ongoing physio and rehab assistant support, a power wheelchair and an accessible van.
The short version
- Who: an older man struck by a motor vehicle, with a severe spinal cord injury (AIS B) and polytrauma.
- Focus: complex discharge planning, home access, care at home and long-term independence.
- Approach: equipment, home modifications, home care coordination, ongoing multidisciplinary rehab and power mobility.
- Outcome: a safe, equipped and modified home, care and rehab in place, and more independent movement at home and in the community.
Identifying details have been left out to protect the client's privacy.
Background
An older man was struck by a motor vehicle and sustained a severe spinal cord injury, classified as ASIA Impairment Scale (AIS) B, along with multiple other traumatic injuries (polytrauma).
After a long period of acute care and rehabilitation, he needed comprehensive occupational therapy (OT) to move safely from hospital to home and to continue his rehabilitation and build independence.
The complexity of his injuries, his significant mobility limits and his long-term care needs meant extensive discharge planning, changes to his home and coordination of community services.
Occupational therapy assessment and intervention
The OT addressed what he needed to get home safely while planning for longer-term independence and participation in his community.
1. Complex discharge planning and equipment
The OT coordinated the equipment and supports he needed for a safe transition home, including:
- A hospital bed and positioning equipment.
- A mechanical lift for safe transfers.
- A manual wheelchair and related mobility equipment.
- A bedside commode and toileting equipment.
- Transportation arrangements.
- Other personal care and transfer equipment.
Each choice took into account his abilities, his care needs, safety and how the equipment would fit and work in his home.
2. Home modifications and accessibility
The OT assessed his home and identified the changes needed for safe access and daily living.
The work focused on the bedroom and bathroom, making room for wheelchair movement, equipment, caregiver access and personal care. The OT coordinated the modifications to support his return home and reduce barriers to independence.
3. Home care and personal support
Because he needed significant help with daily activities, the OT coordinated home care and personal support.
This meant identifying his care needs, setting up caregiver support and making sure services were in place before discharge. The goal was a sustainable arrangement that protected his safety and dignity and let him stay in his community.
4. Ongoing rehabilitation
After discharge, the OT continued to support his rehabilitation as he adapted to his new limitations, worked on independence with daily activities and needed his equipment and home set-up adjusted over time.
The OT coordinated with physiotherapy and rehabilitation assistant (RA) services to set up ongoing treatment at home and in the community, giving him continuity of rehab beyond the hospital.
5. Power mobility and accessible transportation
As his rehabilitation progressed and he became a suitable candidate, the OT assessed him for and prescribed a power wheelchair.
Power mobility was intended to let him move around his home and community more independently, rely less on caregivers to get around and take part in more of the activities that matter to him.
The OT also helped source an accessible wheelchair van, so he could get to appointments and take part in community activities.
Outcome
With coordinated OT, he moved from hospital to a suitably equipped and modified home with care and rehabilitation in place. The work supported:
- A safer, more coordinated move from hospital to home.
- An accessible home with the right equipment.
- Ongoing personal care and home support.
- Continuity of multidisciplinary rehabilitation.
- Power mobility for more independent movement.
- Better access to the community through accessible transportation.
Together, home modifications, assistive technology and coordinated rehab support laid the foundation for ongoing independence and community participation after a life-changing injury.
What the evidence says
This approach is consistent with research on the importance of the home environment, assistive technology and coordinated community supports after spinal cord injury.
- A 2023 scoping review identified modifiable factors that affect the health and quality of life of people with spinal cord injury living in the community. These included sociostructural factors, such as access to health care and to information, funding and policy, and environmental factors such as accessible housing, transportation and assistive technology [1].
- An integrative review found that people with spinal cord injury vary widely, that factors such as social support influence how well they reintegrate into the community, and that rehabilitation and community reintegration programs need to take those differences into account [2].
Together, these findings support OT that extends beyond hospital discharge to cover the home, equipment, caregiver support and the chance to take part in community life.
Why this case matters
This case shows the role occupational therapy plays in complex rehabilitation after severe spinal cord injury and polytrauma.
Rehabilitation doesn't end at the hospital door. Getting back into the community takes careful discharge planning, specialized equipment, an accessible home, the right caregiver support and ongoing multidisciplinary care.
Creative Therapy Consultants helps clients and families through the move from hospital to home, building independence and keeping people connected to their communities. See occupational therapy, complex seating and wheelchair prescription and aged care, or make a referral.
References
- Gurung S, Jenkins H-T, Chaudhury H, Mortenson WB, et al. Modifiable sociostructural and environmental factors that impact the health and quality of life of people with spinal cord injury: a scoping review. Topics in Spinal Cord Injury Rehabilitation. 2023. Read the article
- Gupta S, Jaiswal A, Norman K, DePaul V. Heterogeneity and its impact on rehabilitation outcomes and interventions for community reintegration in people with spinal cord injuries: an integrative review. Topics in Spinal Cord Injury Rehabilitation. 2019;25(2):164-185. Read the article
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