Avoidant and Restrictive Food Intake Disorder: Outcomes for 16 Inpatient Cases to Target Oral Consumption Using a Medical and Behavioral Treatment Model.

INTRODUCTION: Avoidant and restrictive food intake disorder (ARFID) is characterized by restrictions in oral intake and does not include concerns related to body image. Despite the evidence-based medical and behavioral treatments, there is limited research as they apply to ARFID, but the extant research supports hospital-based behavioral therapy. Individuals with ARFID may have comorbidities that can affect treatment, which requires multidisciplinary treatment to provide effective care. Supplementary sources of nutrition may be required for individuals with this diagnosis to ensure they maintain proper nutritional status (eg, enteral feeding). METHODS: A record review from 2015 to 2019 identified 16 participants admitted to an inpatient hospital. Of the sample, 75% of participants had a psychiatric diagnosis and 88% of participants experienced an acute event that preceded their feeding difficulties. Each participant received medical oversight, and instead of a standard treatment approach, behavioral treatment components were individualized based on each participants' presentation. RESULTS: All participants met at least 80% of their admission treatment goals, and 92% of participants who completed their admission consumed 100% of their nutritional needs orally. Follow-up data indicate sustained progress for several months following discharge. CONCLUSION: Our results suggest that a multidisciplinary, medical, and behavioral treatment model is effective for a variety of clinical presentations of ARFID. More research is needed on triggering events that precede restricted food and liquid intake. In addition, the extent to which these treatment components are preferred should be assessed in an effort to maintain treatment gains after discharge.

Acute Flaccid Myelitis.

Acute flaccid myelitis (AFM) is an incompletely understood neurologic disorder occurring in epidemic fashion causing weakness ranging from mild paresis to devastating paralysis in children and some adults. This article reviews the case definition of AFM as well as its epidemiology and association with enteroviral infection. The clinical presentation, diagnostic investigation with particular attention to electrodiagnostics, acute management, and surgical options are described. Clinical outcomes and considerations for acute and long-term rehabilitation management are discussed extensively based on review of current literature, highlighting avenues for further study.

A Primary Care Provider's Guide to Pediatric Spinal Cord Injuries.

Spinal cord injury (SCI) in youth presents with unique manifestations and complications as compared to adult-onset SCI. The primary care clinician must consider the physical, physiological, cognitive, and psychological changes transpiring during childhood and adolescence. Physical changes include increasing size, weight, and bladder volume. Physiologic considerations include decreasing heart rate and increasing blood pressure with age. Cognitive issues include communication, executive functioning, and self-management skills. Lastly, psychological processes involve emotional functioning and establishment of self-identify and autonomy in the context of life with SCI.

Acute flaccid myelitis: Rehabilitation challenges and outcomes in a pediatric cohort.

PURPOSE: To describe one institution's experience in the rehabilitation of children with acute flaccid myelitis (AFM). This study reviews the medical and rehabilitative course and functional outcomes of a cohort of children who underwent Activity Based Restorative Therapy (ABRT) at a single center. METHODS: Children with AFM presenting for rehabilitation between March 2005 and January 2017 were identified and a retrospective chart review was conducted. Changes in medical and functional status were assessed using multiple standardized instruments, as well as a chart review of medical progress. RESULTS: Thirty-one children with AFM treated at our institution in the study time period were identified. Of these, seventeen received inpatient treatment, and fourteen received solely outpatient interventions. Their medical and functional outcomes are described with use of standardized measures when available. CONCLUSIONS: Children with flaccid paralysis due to AFM undergoing structured, comprehensive rehabilitation interventions, even when these are initiated long after paralysis onset, can make significant neurologic and functional gains. Recovery of function and prevention of comorbidities are the main therapeutic targets for interventions in this population.