Chronic Rehabilitation of Acute Flaccid Myelitis

Acute Flaccid Myelitis (AFM) is defined by rapid onset of flaccid paralysis in one or more limbs or bulbar muscles with longitudinal lesions in the gray matter on MRI imaging, following a viral illness. Since tracking was initiated in August of 2014, 673 patients have received a confirmed diagnosis of AFM with biennial outbreaks noted. Limited information is known regarding long term outcomes but current longitudinal studies report persistent paralysis in children with AFM and continued recovery has been documented up to 77 months from onset of illness. Extent of recovery is variable with current data in only small cohorts followed for two years or fewer. Children who participated in intensive activity based restorative therapy (ABRT) have been documented to show functional gains and improved strength in distal to proximal pattern and improvements in functional outcome measures.
Although it is a rare diagnosis, the acute onset of weakness paired with the potential for lasting sequelae requires education to clinicians in a variety of settings. The purpose of this course is to describe intensive ABRT with patients with AFM in the acute and chronic phase of recovery. This course will focus on progress made in therapy during the chronic phase of illness and management of secondary complications. We will describe interventions, discuss outcomes measures, and describe limitations and modifications required due to secondary complications of AFM. Finally, we will discuss patient examples and interventions applicable in multiple settings.