Session Information
Date: Saturday, November 16, 2019
Session Title: Pediatrics Case Report
Session Time: 11:15am-12:45pm
Location: Research Hub - Kiosk 3
Disclosures: Emily J. Kivlehan, MD: Nothing to disclose
Case Description: Six patients were admitted to acute inpatient rehabilitation with clinical and laboratory criteria for probable acute flaccid myelitis (AFM). Cases had a prodrome including URI symptoms (83%) and fever (83%). Initial neurologic impairment was unilateral upper extremity weakness in 67% of cases. Half complained of neck pain at the time of presentation, and all but one patient suffered pain during their course. At some point during course, there was weakness noted in 10/12 upper limbs and 8/12 lower limbs.
Setting: Acute inpatient rehabilitation (AIR)
Patient: Six pediatric patients ranging in age from 1-8 years old (1 male, 5 females).
Assessment/Results: During AIR, average total functional independence measure (FIM) gain was 12 points, motor FIM gain was 7.2 points, and cognitive FIM gain was 4.8 points. The most profound FIM gains were seen in walk/wheelchair and stair navigation (0.4 to 3, 0.4 to 2.5), toilet transfers (0.6 to 2.2), and expressive communication (1.6 to 2.8). Discharge destination was home for all patients.
Discussion: AFM is a subtype of acute flaccid paralysis and heterogenous in presenting symptoms ranging from single limb weakness to quadriplegia with ventilator dependence. In 2018, there were 215 confirmed US cases and no prior literature has described functional outcomes for this outbreak. While AFM has been referred to as “polio-like”, the paralysis of poliomyelitis is characterized by a predilection for lower extremity paralysis; while our patients generally had more upper limb symptoms on presentation. Importantly, we demonstrate significant improvement in functional outcomes with a return to home after AIR admission.
Conclusion: AFM is a rare disorder with a unique presentation and symptomatology for which AIR admission can provide significant functional benefits in the pediatric population.
Level of Evidence: Level V
To cite this abstract in AMA style:
Kivlehan EJ, Deike DE, Sisung C, Hou N, Revivo G. Acute Flaccid Myelitis as a New Cause of Childhood Disability: A Case Series of Acute Inpatient Rehabilitation Outcomes [abstract]. PM R. 2019; 11(S2)(suppl 2). https://pmrjabstracts.org/abstract/acute-flaccid-myelitis-as-a-new-cause-of-childhood-disability-a-case-series-of-acute-inpatient-rehabilitation-outcomes/. Accessed May 12, 2025.« Back to AAPM&R Annual Assembly 2019
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/acute-flaccid-myelitis-as-a-new-cause-of-childhood-disability-a-case-series-of-acute-inpatient-rehabilitation-outcomes/