Case Study. Case Review of Rehabilitation for Two High Voltage Electrical Injuries with Spinal Cord Injury Symptoms

Patient Presentation (age range, injury details, relevant history) This paper reviews two cases with high voltage electrical injury. Case One: 73-year-old male with 14.5% TBSA full-thickness burns to head, neck, torso, BUE. Case Two: 24-year-old male with 69.5% TBSA partial & full-thickness burns to torso, L UE, B LEs, v-fib requiring shock & intubation. Clinical Challenges Both patients exhibited early neurological deficits without radiologic confirmation. Case One: Initial deficits included L transradial amputation, posterior lean, poor proprioception, sensory loss, & inability to maintain midline. Case Two: L shoulder disarticulation, R AKA, sensory & motor deficits to R UE & L LE, required cultured epidermal autografting for definitive wound coverage. Management Approach Intensive, high-frequency therapy was critical to both burn-specific & neurorehabilitation limitations. ICU-related weakness & endurance deficits were also incorporated. Outcomes Case One: Required 62d in the Burn ICU & 3wks of inpatient rehabilitation. At discharge (PBD 83), he ambulated with assistive devices & continued therapy. At 3y post-injury he has full ROM & pliable scars & ambulates with forearm crutches on uneven terrain with mild ataxia. Case Two: Required 91d in Burn ICU & 61d in inpatient rehab. Pt regained some strength and was discharged home (PBD 145) with a power wheelchair, adaptive equipment, & ongoing outpatient neuro & burn rehab. Neither pt achieved full recovery, but both discharged home with significant functional gains. Lessons Learned High voltage electrical injuries impact multiple systems & often present with unpredictable deficits. Neurologic symptoms with immediate or delayed onset consistent with SCI have been reported despite unremarkable imaging. This poses challenges in prognosis & goal setting. Burn scar maturation typically spans 12–18 m, aligning with optimal neuroplasticity timelines for neurologic recovery. Intensive rehabilitation during this window is crucial to maximize outcomes for burn & neurologic sequelae. Rehabilitation is critical to recovery, but limited literature exists outlining interventions or outcomes. Applicability to Practice High voltage electrical injuries with neurological symptoms require early & aggressive rehabilitation. Absence of imaging findings does not exclude functional deficits; treatment should be symptom driven. Recovery potential mirrors burn scar & neuroplasticity timelines, with most progress in the first 12–18 m. Combined burn & neurorehabilitation can lead to meaningful improvement, though full resolution of neurological symptoms remains rare.