Category: Pediatric Rehabilitation; Spinal Cord Injury
Objective : To investigate the frequency of therapy services after diagnosis of acute flaccid myelitis (AFM), and to identify specific occupational therapy (OT) inventions used in our clinic setting. The key to treatment of AFM is the early initiation of PT and OT to begin restoring function to the affected limb(s), and improving daily functioning, even if it is not possible to regain full muscle function (Hopkins, 2017). As a result, there is significant lack of evidence for specific rehab interventions.
The design of this poster is case series. Frequency, clinical features, and OT interventions will be discussed.
The setting was a pediatric inpatient rehabilitation unit and an outpatient clinic at the same institution. .
Participants (or Animals, Specimens, Cadavers) :
The patients were under the age of 8 at initial diagnosis and had CDC confirmation of an AFM diagnosis. Their clinical presentation affected various body parts (two of the three cases with unilateral upper limb), but the mechanism of injury, level of spinal cord involvement, and clinical symptoms were similar.
Interventions included intense OT services (minimum of 3 times a week). Specific occupational therapy inventions were as follows: neuromuscular electrical stimulation, functional electrical simulation, upper limb robotics, weight bearing, custom splinting, aquatic therapy, bi-manual therapy, traditional therapy services (strengthening, ROM, etc.), and the use of mobile arm supports.
Main Outcome Measure(s) :
The primary outcome measurement was a qualitative description of a patient’s ability to engage in age appropriate basic and instrumental activities of daily living (ADLs). Quantitative outcome measures included the WeeFIM, 9 hole peg test, Box and Block Test, range of motion (AROM), and manual muscle testing (MMT). Two of the three patients also used surface level electromyography (EMG) to track muscle activation while targeting individual muscle groups with specific interventions.
Patients participated in >/= 3 days a week of OT services after diagnosis. Positive changes were noted on all outcome measures during OT treatment at our clinic, and detailed descriptions of ability to participate in ADLs were also recorded.
Intense therapy >/= 3 days a week is warranted for children with AFM as soon as they are medically stable evidenced by clinical changes and their impact on function. The therapeutic interventions (above) produced changes in AROM and MMT which allowed patients to engage in age appropriate ADLs with less compensations.
Ashley Binkowski– Occupational Therapy, The Children's Hospital of Philadelphia, West Chester, Pennsylvania