Abstract
The purpose of this poster is to review two case reports highlighting the use of evidence-based practice, an interdisciplinary approach, and standardized assessments in maximizing motor recovery and measuring outcomes for pediatric patients with AFM.
Primary Author and Speaker: Erin Currier
Additional Authors and Speakers: Michelle Penso, Kristen Olwell
Acute Flaccid Myelitis (AFM) is a rare but serious condition affecting the nervous system, specifically the gray matter of the spinal cord. The inflammation within the spinal cord causes muscles and reflexes within the body to become weak (Centers for Disease Control and Prevention, 2019). The emergence of AFM in the United States has grown since 2012 implicating the need for research pertaining to epidemiology, clinical management, and implications for rehabilitation (Messacar, 2016). Limitations in research persist with regard to standardization protocols, predicting the course of the disease, and the identification of long term treatment outcomes (Martin, 2017). This poster will provide rehabilitation outcomes for two pediatric patients with a diagnosis of AFM after completing a multi-modal, evidenced based, activity driven occupational therapy outpatient program.
As of 2018, there were 134 confirmed cases in 33 states. A qualitative research study conducted by Rybczynski et al. (2017), indicated the importance of maximizing recovery of function, the essential components of an activity-based therapy program, and the management of secondary consequences of paralysis and immobility. This poster will highlight the use of an evidence based activity driven therapy program within an outpatient rehabilitation setting. Two patients between the ages of 4 and 5 were identified with confirmed cases of AFM.
To maximize the patients’ recoveries, an evidenced-based, interdisciplinary approach was utilized. The literature suggests that the following activities and modalities have been shown to improve functional outcomes in children with AFM: weight bearing activities, locomotor training, functional electrical stimulation, task-specific practice, massed practice, and aquatic therapy (Rybczynski et al. 2017). Standardized outcome measures were utilized for tracking patient progress throughout this therapy program; these included goniometry measurements, the Melbourne Assessment 2: a test of unilateral upper limb function (MA2), and the Assisting Hand Assessment (AHA). Through utilizing the aforementioned activities and modalities as well as documenting progress through the aforementioned assessments, we have found functional improvements in both patients. Despite functional improvements, recovery remains incomplete. Deficits continue to be noted in proximal joints of the affected upper extremity, however improvements in the distal joints have been observed. These strength and active range of motion improvements provide important insight into early family education, establishing realistic and achievable therapeutic goals, and introducing compensatory strategies and techniques to facilitate functional improvements.
Interdisciplinary care is essential in outpatient rehabilitation in order to maximize patients’ rehabilitation potential through incorporating interdisciplinary collaboration, patient goals, and values and interests, occupational therapy was able to make recovery motivating and maximize therapy potential. The occupational therapy profession is an essential component in facilitating recovery in patients afflicted with an AFM diagnosis as it places the patients’ occupations and values at the forefront of their rehabilitation and utilizes at activity-based therapy program.
Centers for Disease Control and Prevention. (2019, May 6). About Acute Flaccid Myelitis. Retrieved May 22, 2019, from https://www.cdc.gov/acute-flaccid-myelitis/about-afm.html
Martin, JA., Messacar, K., Yang, ML., Maloney, JA., Lindwall, J., Carry, T., Kenyon, P., Sillau, SH., Olescek, J., Tyler, KL., Dominguez, SR., Schreiner, TL. (2017). Outcomes of Colorado children with acute flaccid myelitis at 1 year. American Academy of Neurology, 89, 129-137
Messacar, K., Schreiner, T.L., Van Haren, K., Yang, M., Glaser, C.A., Tyler K.L., Dominguez, S.R. (2016). Acute flaccid Myelitis: A Clinical Review of US Cases 2012-2015. Annals of Neurology, 80, 326-38
Rybczynski, S., Dean, J., Melicosta, M. (2017). Pediatric spinal cord injury due to acute flaccid myelitis: epidemiology, clinical management, and implications for rehabilitation. Current Physical Medicine and Rehabilitation Reports, 5, 113-120