1237 - Multidisciplinary Rehabilitation Strategies in a Patient with Congenital Insensitivity to Pain and Anhidrosis

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

GL

Gabriel M. Lartigue, MS

Medical Student
Renaissance School of Medicine at Stony Brook University
Montebello, New York, United States
SL

Schan Lartigue, MD

Resident, PGY-2
Yale New Haven Hospital
New Haven, Connecticut, United States

Co-Author(s)

SM

Sergio Mosquera Limas, DO

Resident, PGY-2
Yale New Haven Hospital
New Haven, Connecticut, United States
NM

Necolle Morgado-Vega, DO

Medical Director, YNHH IRU/Associate Professor of Clinical Orthopaedics and Rehabilitation
Yale School of Medicine.
Fairfield, Connecticut, United States

Corresponding Author(s)

MR

Marc Rosen, MD

Attending
Yale New Haven Hospital
New Haven, Connecticut, United States

Submitter(s)

SL

Schan M. Lartigue, MD

Yale New Haven Hospital
New Haven, Connecticut, United States

Case Diagnosis: Congenital Insensitivity to Pain and Anhidrosis (CIPA) with developmental delay.

Case Description: The patient is a 23-year-old female with a past medical history of CIPA, developmental delay, self-harming behaviors, and multiple orthopedic injuries including various bone fractures, acquired left hip dysplasia, and right Charcot knee. She was admitted for 3 months of progressive ambulatory decline and two days of failure to stand. At baseline, the patient ambulates utilizing a hip-knee-ankle-foot orthotic with supervision and has a cervical collar for safety following a cervical myelopathy injury secondary to self-harming behaviors. She was found to have an L4-L5 discitis/osteomyelitis on MRI imaging with culture-negative epidural and psoas abscesses with concomitant severe L3-L5 spinal canal narrowing. She underwent L4-L5 decompression, L3-S1 fusion, and was started on a 6-week IV antibiotic regimen before discharge to acute rehab. Throughout her hospitalization, her care was complicated as she was minimally participatory with staff requiring her mother’s participation for her activities of daily living (ADL) care and behavioral support.

Discussions: CIPA is a rare hereditary sensory and autonomic neuropathy characterized by insensitivity to pain, anhidrosis, and is often associated with developmental delay. Patients are at high risk for unrecognized injuries, infections, and functional decline. In this context, acute rehabilitation must prioritize patient and caregiver education on injury prevention, safe ADL performance, and early detection of complications. Protective strategies include the use of orthotics, environmental modifications, and structured routines for skin and joint checks with an emphasis on caregiver training given commonly associated cognitive impairments.

Conclusions: This case underscores the importance of acute rehabilitation focus on caregiver education and protective strategies for patients with CIPA and developmental delay. Interdisciplinary collaboration and active caregiver involvement are essential to optimize safety, support functional recovery, and prevent re-injury in this high-risk population.