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Rehabilitation Outcomes in Children with Acute Flaccid Myelitis from 2014 to 2019: A Multicenter Retrospective Review
Acute Flaccid Myelitis (AFM) is a childhood illness characterized by sudden onset weakness impairing function. The primary goal was to compare the motor recovery patterns of patients with AFM who discharged home or to inpatient rehabilitation. Secondary analyses focused on recovery of respiratory status, nutritional status, neurogenic bowel and bladder in both cohorts.
Eleven tertiary care centers in the United States performed a retrospective chart review of children with AFM between January 1st, 2014 and October 1st, 2019. Data included demographics, treatments, and outcomes on admission, discharge, and follow-up visits.
Medical records of 109 children met inclusion criteria. 67 children required inpatient rehabilitation while 42 children discharged directly home. The median age was 5 years (range 4 months – 17 years) and median time observed was 417 days (Interquartile range = 645 days). Distal upper extremities recovered better than the proximal upper extremities. At acute presentation, children who needed inpatient rehabilitation had significantly higher rates of respiratory support (p<0.001), nutritional support (p<0.001) and neurogenic bowel (p=0.004) and bladder (p=0.002). At follow up, those who attended inpatient rehabilitation continued to have higher rates of respiratory support (28% vs 12%, p=0.043) however nutritional status and bowel/bladder function were no longer statistically different.
All children made improvements in strength whether they discharged home or to inpatient rehabilitation. Proximal muscles remained weaker than distal muscles in the upper extremities. Children who qualified for inpatient rehabilitation had ongoing respiratory needs at follow up, however, recovery of nutritional status and bowel/bladder were similar