Acute Flaccid Myelitis

AFM is an incompletely understood syndrome of flaccid paralysis, predominately affecting children, preceded by acute infectious symptoms and identified by lesions involving the spinal cord gray matter. Although several treatments have been used in an attempt to halt or limit neurologic damage occurring during the acute phase of the disease, none have presently been proven effective, leaving most affected individuals with lasting impairments. There is substantial heterogeneity in the clinical presentation, pattern, and severity of paralysis, and trajectory of recovery for various patients, necessitating a tailored, individualized approach to rehabilitation. Employment of a skilled multidisciplinary rehabilitation team to address AFM's extensive and often profound impacts on a patient's mobility, respiratory status, autonomic function, communication, social interaction, and mental health is essential. Significant gaps in the current knowledge of AFM persist in every aspect of the disease. Literature interpretation is confounded by a broad and evolving epidemiologic case definition, which has been engineered to optimize reporting rather than provide clinical diagnostic precision. An understanding of known epidemiology, characteristics, workup, therapies, and potential alternative diagnoses is nevertheless necessary to best equip providers combating AFM and its long-term sequelae. Pediatric and adult rehabilitation physicians are uniquely positioned to observe the course of AFM, scrutinize interventions, and strive to maximize function for years to come.