Neuro DCI

Question:
I am a hyperbaric doctor working in Egypt, Alexandria 2 days ago I received a patient (32 years old) from sharm el shiekh which is 900 km away from Alexandria after having a diving accident and was on treatment for the last 24 days in sharm el shiek
went for fun dive with his friend after 30 days of successive dives, he went down to 109 meter depth with his body and all of a sudden he was noked and start to fee run of air he and his body shoot up to the surface without regulator in mouth.
On the surface his body was in coma, he has sever pain all over his body, but he climb up to the boat and helped his body to receive his oxygen, he continue to drive the boat back to the harbor, Half an hour later, losing muscle power and dropped with quadriplegia and chest pain, vomiting, drowsiness, it takes 2 hours to reach the chamber where he received oxygen and aspirin
IN THE CHAMBER IN SHARM
Table 6 A, 7 HOURS no improvement of quadriplegia, flaccid paralysis, incontinent, loss of sensation. Where he transferred to another chamber in sharm where he was put on HBO REGIME + hydrocort+ fluids, for 24 days
After a week of treatment upper limbs recovered but still paraplegic, incontinent, loss of sensation below diaphragm.
IN ALEXANDRIA CHAMBER
Where he was transferred 2 days ago with the same late conditions
Treatment HBO 2HOURS ON 18 M.
Vasodilators Sermion
Steroids
Physiotherapy

QUESTIONS
What is the protocol of physiotherapy for such cases?
What is the new Trent of treatment of such cases?
What are the signs of responding to treatment?
What is the prognosis of the case?
Your considerations are highly appreciated

Answer:
The clinical situation is not looking very good, and, given the relative apparent stability, it would not seem any longer useful to continue with HBO treatment, unless objective improvements can be observed under pressure: that means objective changes of the neurological functions during the administration of HBO: change from paraplegic to paraparetic, improvement of range of motion in any district, clear and objective improvement in the matameric level of sensation, and the like.
Neurorahabilitation protocols used in similar cases are not different from the ones used in spinal injuries, with the only difference that DCI patients normally show a better and faster recovery, particularly for what concerns the sphincterial control. If this case follows the usual pattern, one would expect to observe a shift towards paraparesis within 60-90 days, normally preceded by a trend to recovery of the sphincterial functions ( bladder more than rectum, usually ). Muscular strength usually follows, although I would not be surprised if this patient will show a clearly paretic picture, with spasticity and spastic / paretic gait as the final picture. As for bladder re-education, it would be important to use all the possible means to help it, by timing the opening of the catheter and stimulating the patient to actively being conscious of its function.
Considering the situation you describe, my opinion on the prognosis is not very favourable, for the recovery of fully autonomous motor functions. It is likely that you will observe, with time, a gradual recovery, which, I am afraid would not go further than a paraparetic spastic situation (with some extent of autonomous deambulation hopefully), certain sequelae in the sphincter function control and possibly signifiucant neurosensory sequelae.
I will be happy to interact with you in case I can be of further help.