Table 3

Impairments and rehabilitation interventions

Impairment	Description	Management
Psychological	Anterograde memory loss with gaps in recall for recent events.	Attentional control mechanisms taught.
Psychological	Sleep disturbance, low mood, anxiety and trauma symptoms.	Supported with visual imagery relaxation exercises and guided relaxation.
Cardiorespiratory	Significant reduction in exercise tolerance with desaturation to 87% oxygen saturation when walking 100 m. Medical Research Council (MRC) dyspnoea 4/5.	Cardiorespiratory training cycling, squats, stairs and high knee marching with close monitoring using the Borg Rating of Perceive Exertion Scale to exercise to a moderate level of intensity. He showed improvement in saturations and MRC dyspnoea score 2 on discharge.
Speech and language	Low volume and hoarse voice.	Voice therapy techniques and swallow assessment.
Upper limb	Left hand oedema.	Intensive 10-day programme of contrast bathing, Coban wrapping and elevation.
	Reduced ability to grasp using right hand and generalised upper limb weakness as described.	Neuromuscular electrical stimulation (on the right finger extensors to strengthen his active grasp and release now able to grasp a ball. Daily stretching and exercise regime.
	Lack of left elbow flexion.	Dynamic elbow flexion splint and referral for consideration for tendon transfer surgery.
Function	Required complete assistance on admission for all activities of daily living.	Compensatory and adaptive methods taught to increase independence in personal tasks. A strap-stylus and environmental control system provided to allow him to control his surroundings using his phone. Fatigue management techniques were taught.
Pain management	Mechanical shoulder pain related to muscle wasting and severe neuropathic pain.	Titration of medication and tigger point injections reducing Visual Analogue Scale rating from 9/10 severity to 2/10. Upper limb sling provided to deweight his left arm and avoid further mechanical pain.
Lower limb/mobility	Generalised weakness with an inability to transfer independently or mobilise with a Rivermead Mobility Index (RMI) on admission of 7/15.	Strength and cardiorespiratory programme improving RMI on discharge to 13/15, return of lower limb power and ability to mobilise independently.