Disclosures: Kayla M. Williams, MD: No financial relationships or conflicts of interest

Case Diagnosis: A 16-year-old male with Guillain-Barre Syndrome (GBS), presumed acute motor axonal neuropathy (AMAN) variant

Case Description or Program Description: This patient presented with global weakness, paresthesias and acute respiratory failure and EMG consistent with AMAN. He was treated with PLEX and IVIG. After acute hospitalization, he was admitted to inpatient rehabilitation where he presented with tracheostomy and ventilator dependence and was receiving all nutrition via PEG tube. Functionally, he demonstrated retention of distal cervical spine movement but no gross or fine motor movement at his upper or lower extremities.

Setting: acute inpatient rehabilitation

Assessment/Results: Due to complex social circumstances, he remained admitted to acute inpatient rehabilitation in CPS custody awaiting placement for 8 months at the time of this report. He was able to progress from ventilator dependence to decannulation. With physical and occupational therapy, he recovered voluntary muscular activation and control of bilateral upper and lower extremities. His shoulder girdle function is within normal limits. Forearm and digital function continues to emerge as compensatory strategies persist. He progressed from total assistance for all daily activities to dressing, bathing, and eating with minimal to moderate assistance. He is able to engage in standing-based activities and walk 400 feet with a rolling walker and contact guard assistance. Speech therapy interventions facilitated normalization of swallow and he was able to progress to a full oral diet with regular, thin liquids.

Discussion (relevance): The profound functional improvement of a patient with AMAN GBS and prolonged acute inpatient rehabilitation admission is described. Further investigation into the utility of a prolonged course of rehabilitation may be helpful in advocating for longer inpatient rehabilitation admissions. This may decrease caregiver burden, medical equipment needs and overall resource utilization associated with significant chronic disability.

Conclusions: An extended course of intensive acute inpatient rehabilitation supported a significant magnitude of functional improvement in a patient with AMAN GBS.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/functional-outcomes-in-a-pediatric-guillain-barre-syndrome-patient-with-prolonged-inpatient-rehabilitation-admission-a-case-report/