1123 - Catch me if you can: a case study of high-intensity gait training for a pediatric patient post right basal ganglia infarct

Case Diagnosis: Right basal ganglia infarct post viral vasculitis

Case Description: The patient was a healthy, typically developing four-year-old female with no prior medical history who presented with sudden onset left-sided weakness, altered mental status, and incontinence in October 2022. On admission, her hypercoagulable workup and CSF studies were unremarkable. She was determined to have vasculitis, and inpatient management included steroids and thrombosis risk management with Lovenox followed by daily aspirin. She transitioned to inpatient rehabilitation, where she progressed functionally and started oral baclofen for spasticity management. Following her inpatient stay, the patient referred to outpatient physical therapy to address ongoing concerns regarding her abnormal gait pattern, impaired balance, increased dependence for transfers, and impaired endurance. Although less common in pediatric care, the decision was made to focus on high-intensity gait training to address these concerns, with significant functional progress as she progressed in her rehabilitation course.

Discussions: After 12 months of outpatient physical therapy, which included participation in a high-intensity gait training program, the patient demonstrated independence with transfers, ambulation, and stair navigation. Functional mobility, gross motor skills, and participation in ADLs significantly improved per standardized outcome measures, including the 6 Minute Walk Test, Gait Speed test, and PDMS-2. Video gait assessment included 2-dimensional analysis of objective gait parameters across the period of care with noted improvements across multiple aspects.

Conclusions: This is the first case in the literature to outline the implementation of a high-intensity gait training program to address mobility deficits secondary to pediatric stroke. This patient's rehabilitative course will hopefully add to future research to provide patients and families with expectations for their recovery. Although strongly supported in adults post stroke, this training paradigm should be further tested in other contexts with pediatric populations to determine its appropriateness to address motor deficits in these patients.