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Szalewska D. 1, Kusiak-Kaczmarek M. 1, Sićko Z. 2, Tomaszewski J. 1, Niedoszytko P. 1, Szklarska D. 1, Bakuła S. 1
1 Department of Rehabilitation, Medical University of Gdańsk, Gdańsk, Poland;
2 National Centre for Hyperbaric Medicine, Institute of Maritime and Tropical Medicine in Gdynia, Medical University of Gdańsk, Gdańsk, Poland
Recreational scuba diving is becoming increasingly popular in the countries of the former Soviet Union. A 37-year-old man from Ukraine was admitted to the Centre for Hyperbaric Medicine with type II decompression sickness (DCS) following a deep scuba dive at 70 m trimix and emergency surfacing without required decompression. In the physical examination he presented with tetraparesis, hypaesthesia of the trunk and lower limbs, dysfunction of the sphincter, ataxia of the upper limbs and nystagmus. He was initially treated in Kiev, then at the Institute of Maritime and Tropical Medicine in Gdynia. In MRI a hyperdense ischemic lesion and enlarged volume of the cervical spinal cord C2-C4/C5 were found; a similar lesion was described in the thoracic part of the spinal cord. On admission at the Clinic of Rehabilitation he was bedridden, unable to attend to his own bodily needs without assistance (modified Rankin scale 4/5, Index Barthel 6). Initially, the physiotherapy programme comprised respiratory muscle training, gradual mobilization to sitting and standing positions, active–passive exercises and exercises in relieving the lower and upper limbs, and passive verticalization of the patient. Balance exercises and short-term progressive resistance exercises of the upper and lower limbs were then added. Training sessions were carried out six days per week, twice a day for three weeks. After rehabilitation, patient was able to walk without assistance and go upstairs. Slight symptoms of spastic paraparesis and neurogenic urinary bladder with instability of the detrusor muscle persisted. The patient required some help in normal day-to-day activities.