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Rehabilitation for CNS vasculitis patients

Children with CNS Vasculitis can present with serious neurological symptoms and impairments such as cognitive and behavioural changes, seizures, hemiparesis, sensorimotor deficits, and movement disorders[1,2].  Neurological changes can have significant impact on a child’s motor skills and function. Children with CNS Vasculitis may have difficulty with activities of daily living (eating, dressing), motor skills (balance, strength, mobility), cognitive skills (thinking, socializing, school work, language).
 

Rehabilitation  professionals, such as Occupational Therapists (OT), Physiotherapists (PT), and Speech Language Pathologists (SLP), are important partners in the assessment and treatment of children with CNS Vasculitis.

Rehabilitation

Rehabilitation Therapy may include:

  • Occupational Therapists - specially trained to assess and treat difficulties  activities of daily living (ADLs), fine motor, cognitive and swallowing skills.
  • Physiotherapists - specially trained to assess and treat changes in gross motor skills, mobility and pain.
  • Speech Language Pathologists - specially trained to assess and treat changes in speech,  and communication, and swallowing skills.
  • Together, rehabilitation professionals can help to restore function and allow children with motor and cognitive changes to participate maximally in social, leisure, and school activities.

Rehabilitation Therapy may take place in:

  • Acute care hospitals: When a child is admitted for disease management, rehabilitation therapy can be initiated to assess a child’s functional changes from baseline, beginning rehabilitation therapy, and develop into a plan for the child’s rehabilitation discharge needs (i.e. supports at home, school, and therapy follow-up).
  • Rehabilitation hospitals: Depending on the severity of impairment, some children may require intensive therapy at a rehabilitation hospital. There are children’s rehabilitation hospitals that have specialized programs for children with neurological injuries and offer multidisciplinary services which provide intensive therapy aimed at restoring function. Therapies are provided as either an inpatient or outpatient, and often involve participation in school and recreational activities.
  • Schools: Therapists can provide in-school assessment and treatment to assist a child to function maximally in the classroom.

Rehabilitation Outcome Measures

There is currently no specific rehabilitation outcome tool validated for use in CNS Vasculitis. Research is currently underway to validate a motor outcome tool for use in CNS Vasculitis patients.  In the meantime, these outcome measures may help clinicians to assess areas of impairment and identify a child’s rehabilitation needs:

 Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2)[3]

Gross Motor Functional Measure (GMFM)[4]

  • Designed to assess changes in gross motor function in children with Cerebral Palsy and regularly used in children with acquired brain injury[3].
  • More information is available at: https://canchild.ca/en/resources/44-gross-motor-function-measure-gmfm
  • Children’s Orientation and Amnesia Scale (COAT)[5].
  • Standardized measures  designed to assess cognitive functioning in children and adolescents with an acquired brain injury.
  • Composed of 16 items, the COAT addressed 3 areas of cognitive functioning:  general orientation, temporal orientation, and memory.

References:

  1. Hutchinson C, Elbers J, Halliday W, Branson H, Laughlin S, Armstrong D, Hawkins C, Westmacott R, Benseler SM. Treatment of small vessel primary CNS vasculitis in children: An open-label cohort study. The Lancet Neurology 2010;9:1078-84.
  2. Benseler SM, Silverman E, Aviv RI, Schneider R, Armstrong D, Tyrrell PN, deVeber G. Primary central nervous system vasculitis in children. Arthritis & Rheumatism 2006;54:1291-7.
  3. Deitz JC, Kartin D, Kopp K. Review of the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2). Physical & Occupational Therapy in Pediatrics 2007;27:87-102.
  4. Russell D RP, Gowland C, Hardy S, Lane M, Plews N, McGavin H, Cadman D, Jarvis S. Gross Motor Function Measure. 2nd ed. Toronto, Ontario, Canada; 1993.
  5. Iverson GL, Iverson AM, Barton EA. The Children’s Orientation and Amnesia Test: Education status is a moderator variable in tracking recovery from TBI. Brain Injury 1994; 8(8): 685-688.

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