Recommendations for Therapy following Nerve Transfer for Children with Acute Flaccid Myelitis

Abstract

Aim

To provide recommendations for pre- and post-operative occupational and physical therapy for children with acute flaccid myelitis (AFM).

Methods

Writing panel members consisted of an interdisciplinary team of seven healthcare professionals specializing in the care of children with AFM. The panel reviewed background material on AFM, nerve transfer, and rehabilitation principles applied to pediatrics. Recommendations were prioritized if evidence was available. Where there was no known evidence to support a recommendation, this was noted.

Recommendations

Communication and coordination among interprofessional team members are vital to a comprehensive family-centered rehabilitation program. Surgical planning should include team preparation accounting for frequency, duration, and timing of treatment, as well as individual characteristics and developmental status of the child. Recommendations for pre-operative and six phases of post-operative therapy address assessment, strengthening, range of motion, orthoses, performance of functional activity, and support of the family.

Conclusion

Rehabilitation following nerve transfer in children with AFM requires interdisciplinary collaboration and a multisystem approach to assessment and treatment. As new evidence becomes available, recommendations may be revised or replaced accordingly.

Keywords:

• Acute flaccid myelitis
• nerve transfer
• occupational therapy
• pediatrics
• physical therapy
• rehabilitation

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Julie M. Werner

Julie M. Werner, PhD, OTR/L, CHT is Clinical Scientist at the Institute for Nursing and Interprofessional Research at Children's Hospital Los Angeles and an occupational therapist in the Division of Pediatric Rehabilitation Medicine at Children's Hospital Los Angeles.

Jamie Berggren

Jamie Berggren, BS is an Occupational Therapist in the Division of Pediatric Rehabilitation Medicine at Children's Hospital Los Angeles.

Gina Kim

Gina Kim, MA is an Occupational Therapist in the Division of Pediatric Rehabilitation Medicine at Children's Hospital Los Angeles.

Kimberly Loffredo

Kimberly Loffredo, BS is an Occupational Therapist in the Division of Pediatric Rehabilitation Medicine at Children's Hospital Los Angeles.

Marielle Pascual

Marielle Pascual, BS is an Occupational Therapist in the Division of Pediatric Rehabilitation Medicine at Children's Hospital Los Angeles.

Emmanuelle Tiongson

Emmanuelle Tiongson, MD is a board-certified Child Neurologist at Children's Hospital Los Angeles and Clinical Assistant Professor of Pediatrics at the Keck School of Medicine of the University of Southern California.

Mitchel Seruya

Mitchel Seruya, MD is Director of the Hand and Upper Extremity Program and Brachial Plexus Clinic in the Division of Plastic and Maxillofacial Surgery at Children's Hospital Los Angeles and Associate Professor of Clinical Surgery at the Keck School of Medicine of the University of Southern California.