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Poster 249: Experience With Younger Patients in a Post-Polio Clinic: A Case Series
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Results: On IRF admission, she presented with no antigravity strength in all 4 limbs, persistent hyponatremia, hypertension, and poor oral intake. After 6 weeks, she demonstrated most dramatic improvements in cognition and mobility, with a total FIM score of 60. She experienced another episode of AIP during rehabilitation. Discussion: This is the first reported case, to our knowledge, of AIP management in an IRF. Through comprehensive interdisciplinary management, function and control of AIP improved. This required weaning of, adjustments to, or avoidance of many medications; modification to nutrition; judicious progression of strengthening and activities; environmental changes; and development of a home management plan. FIM score improvement was most notable in cognition and mobility/locomotion. Although the pathophysiology for the neurologic complaints is not well understood, significant recovery is anticipated. Conclusions: Inpatient rehabilitation supports the continuum of care for patients with AIP including transition into the community. AIP is rare and often confused with more typical neurologic conditions. Comprehensive interdisciplinary rehabilitation plays an important role in AIP management.
Poster 248 Etiology of Heart Failure in Guillain-Barre ´ Syndrome: A Case Report. Vivek M. Mehta, MD (Downstate Medical Center, Brooklyn, NY); Getahun Kifle, MD; Paul Lin, MD. Disclosures: V. M. Mehta, None. Patients or Programs: A 22-year-old African American female. Program Description: The patient with a history of alcohol abuse presented to emergency department with confusion with associated nausea and vomiting. During her intensive care unit admission, she had lower extremity edema, and an echocardiogram found 15%-20% ejection fraction (EF) with unclear etiology for cardiomyopathy. After a week, she became more alert, but was found to have decreased muscle strength in all extremities, areflexia and intact sensation. The patient was diagnosed with Guillain-Barre´ Syndrome (GBS), as electromyography revealed demyelinating polyneuropathy and was started on intravenous immunoglobulin (IVIG). Bedside therapy was started and her muscle strength and edema improved. Furthermore after admission to acute rehabilitation, her strength improved to 4/5 in each extremity, deep tendon reflexes returned and her lower extremity edema resolved. Follow-up echocardiogram showed 55%60% EF 3 weeks later. Setting: Inpatient rehabilitation unit. Discussion: GBS is a demyelinating polyneuropathy, commonly presents with ascending muscle weakness with possible compromise of respiratory function. Autonomic dysfunction is a known GBS cardiac manifestation, in contrast only 1
PRESENTATIONS
case report was linked to cardiomyopathy. This patient gives evidence that the etiology of her cardiomyopathy was GBS. Conclusions: The patient gradually developed cardiac failure within 1 week of the onset of symptoms, responded to mobilization and IVIG, the treatment for GBS. Upon aggressive bedside therapy, the edema improved. Her inpatient rehabilitation gave her significant improvement in function and with progressive ambulation her edema began to subside. She became modified independent with activities of daily living and ambulation, and was discharged home. The rapid resolution of heart failure after treatment in this patient offers an interesting presentation of cardiomyopathy in case of GBS.
Poster 249 Experience With Younger Patients in a PostPolio Clinic: A Case Series. Judith A. Glaser, DO (National Rehabilitation Hospital, Washington, DC); Lauro Halstead, MD. Disclosures: J. A. Glaser, None. Patients or Programs: Seven patients under the age of 50 years with a medical history of acute paralytic poliomyelitis (APP) as a child. Program Description: As the polio population ages, the mean age of patients seen in our clinic has increased. At the same time, we are also seeing a younger cohort of survivors. In 2009, we evaluated 7 new patients, with a mean age of 40 years (range, 34-44) representing 19% of all new patients seen. These patients contracted APP at a mean age of 16 months between the years 1960 and 1977 in their home countries. All of the patients immigrated to the United States in early adulthood. Six presented with complaints of new weakness, decline in function, fatigue, and pain consistent with post-polio syndrome (PPS). One was pregnant, 6 are married and 5 have 1 or more children under the age of 10. Setting: Outpatient clinic. Results: There are 2 cohorts seen in our clinic: an older group who typically contracted APP during the mid-20th century epidemics in this country and a younger group who had polio as infants in developing countries and then immigrated here as adults. Discussion: Despite the global effort to eradicate polio, there are many who became infected years after polio was eliminated in this country. The World Health Organization estimates there are between 10 and 20 million polio survivors worldwide. Meanwhile, there has been a steady decline in the number of survivors from the mid-century epidemics in the United States. In contrast to the typical older patient, the younger polio survivors present a different and challenging mix of issues such as schooling, work, and raising a family. Conclusions: While polio patients are getting older, there is a younger cohort of immigrants, especially in metropolitan areas, who will continue to need post-polio care from physiatrists well into the future.
Results: On IRF admission, she presented with no antigravity strength in all 4 limbs, persistent hyponatremia, hypertension, and poor oral intake. After 6 weeks, she demonstrated most dramatic improvements in cognition and mobility, with a total FIM score of 60. She experienced another episode of AIP during rehabilitation. Discussion: This is the first reported case, to our knowledge, of AIP management in an IRF. Through comprehensive interdisciplinary management, function and control of AIP improved. This required weaning of, adjustments to, or avoidance of many medications; modification to nutrition; judicious progression of strengthening and activities; environmental changes; and development of a home management plan. FIM score improvement was most notable in cognition and mobility/locomotion. Although the pathophysiology for the neurologic complaints is not well understood, significant recovery is anticipated. Conclusions: Inpatient rehabilitation supports the continuum of care for patients with AIP including transition into the community. AIP is rare and often confused with more typical neurologic conditions. Comprehensive interdisciplinary rehabilitation plays an important role in AIP management.
Poster 248 Etiology of Heart Failure in Guillain-Barre ´ Syndrome: A Case Report. Vivek M. Mehta, MD (Downstate Medical Center, Brooklyn, NY); Getahun Kifle, MD; Paul Lin, MD. Disclosures: V. M. Mehta, None. Patients or Programs: A 22-year-old African American female. Program Description: The patient with a history of alcohol abuse presented to emergency department with confusion with associated nausea and vomiting. During her intensive care unit admission, she had lower extremity edema, and an echocardiogram found 15%-20% ejection fraction (EF) with unclear etiology for cardiomyopathy. After a week, she became more alert, but was found to have decreased muscle strength in all extremities, areflexia and intact sensation. The patient was diagnosed with Guillain-Barre´ Syndrome (GBS), as electromyography revealed demyelinating polyneuropathy and was started on intravenous immunoglobulin (IVIG). Bedside therapy was started and her muscle strength and edema improved. Furthermore after admission to acute rehabilitation, her strength improved to 4/5 in each extremity, deep tendon reflexes returned and her lower extremity edema resolved. Follow-up echocardiogram showed 55%60% EF 3 weeks later. Setting: Inpatient rehabilitation unit. Discussion: GBS is a demyelinating polyneuropathy, commonly presents with ascending muscle weakness with possible compromise of respiratory function. Autonomic dysfunction is a known GBS cardiac manifestation, in contrast only 1
PRESENTATIONS
case report was linked to cardiomyopathy. This patient gives evidence that the etiology of her cardiomyopathy was GBS. Conclusions: The patient gradually developed cardiac failure within 1 week of the onset of symptoms, responded to mobilization and IVIG, the treatment for GBS. Upon aggressive bedside therapy, the edema improved. Her inpatient rehabilitation gave her significant improvement in function and with progressive ambulation her edema began to subside. She became modified independent with activities of daily living and ambulation, and was discharged home. The rapid resolution of heart failure after treatment in this patient offers an interesting presentation of cardiomyopathy in case of GBS.
Poster 249 Experience With Younger Patients in a PostPolio Clinic: A Case Series. Judith A. Glaser, DO (National Rehabilitation Hospital, Washington, DC); Lauro Halstead, MD. Disclosures: J. A. Glaser, None. Patients or Programs: Seven patients under the age of 50 years with a medical history of acute paralytic poliomyelitis (APP) as a child. Program Description: As the polio population ages, the mean age of patients seen in our clinic has increased. At the same time, we are also seeing a younger cohort of survivors. In 2009, we evaluated 7 new patients, with a mean age of 40 years (range, 34-44) representing 19% of all new patients seen. These patients contracted APP at a mean age of 16 months between the years 1960 and 1977 in their home countries. All of the patients immigrated to the United States in early adulthood. Six presented with complaints of new weakness, decline in function, fatigue, and pain consistent with post-polio syndrome (PPS). One was pregnant, 6 are married and 5 have 1 or more children under the age of 10. Setting: Outpatient clinic. Results: There are 2 cohorts seen in our clinic: an older group who typically contracted APP during the mid-20th century epidemics in this country and a younger group who had polio as infants in developing countries and then immigrated here as adults. Discussion: Despite the global effort to eradicate polio, there are many who became infected years after polio was eliminated in this country. The World Health Organization estimates there are between 10 and 20 million polio survivors worldwide. Meanwhile, there has been a steady decline in the number of survivors from the mid-century epidemics in the United States. In contrast to the typical older patient, the younger polio survivors present a different and challenging mix of issues such as schooling, work, and raising a family. Conclusions: While polio patients are getting older, there is a younger cohort of immigrants, especially in metropolitan areas, who will continue to need post-polio care from physiatrists well into the future.