ABSTRACT
Although the diagnosis of and therapy for acute disseminated encephalomyelitis (ADEM) have been extensively investigated, the role of rehabilitation in modifying its functional outcome has received little attention in the literature so far. We report a case of pediatric ADEM who showed complete functional recovery following early rehabilitative treatment, started in the Intensive Care Unit.
Subject(s)
Attention , Encephalomyelitis, Acute Disseminated/rehabilitation , Physical Therapy Modalities , Recovery of Function/physiology , Child , Encephalomyelitis, Acute Disseminated/physiopathology , Encephalomyelitis, Acute Disseminated/psychology , Humans , MaleABSTRACT
A 5-year old female presented with acute tetraparesis and areflexia. Initial imaging and cerebrospinal fluid analysis were suggestive of acute disseminated encephalomyelitis (ADEM). Minimal clinical response with intravenous steroids prompted further work up. Limited nerve conduction studies suggested possible acute motor-sensory axonal neuropathy, a rare variant of Guillain-Barré syndrome (GBS). Repeat imaging was compatible with polyradiculopathy indicating concomitance of ADEM and GBS. The patient suffered severe motor deficits and neuropathic pain. Slow but significant functional recovery was noted after intensive inpatient rehabilitation followed by continued rehabilitation via home health services.
Subject(s)
Encephalomyelitis, Acute Disseminated/rehabilitation , Encephalomyelitis, Acute Disseminated/therapy , Guillain-Barre Syndrome/rehabilitation , Guillain-Barre Syndrome/therapy , Child, Preschool , Encephalomyelitis, Acute Disseminated/complications , Female , Guillain-Barre Syndrome/complications , Humans , Magnetic Resonance Imaging , Treatment OutcomeABSTRACT
The aim of this study is to describe rehabilitation problems in patients with acute disseminated encephalomyelitis. The study examines retrospective clinical data. Data are reported from 4 patients, who were consecutively admitted and examined with the Functional Independence Measure and magnetic resonance imaging. It was found that the lesions in the brains affected by acute disseminated encephalomyelitis are widespread, but become smaller with time. Motor symptoms dominate at first, but recovery is quite good. Social and cognitive functions are also affected, however, and require a much longer recovery time. These symptoms are, thus, the dominating problem in the rehabilitation ward. At clinical follow-up after 3 years the cognitive problems still influenced the lives of the patients. It is concluded that social and cognitive problems seem to be common in patients with acute disseminated encephalomyelitis. Recovery in these areas takes a long time and this is the main rehabilitation problem, since it affects the capability of the person to reintegrate into society.
