718 - The Fast and the Functional: From Bed-Bound to Battle-Born. A Case of Pediatric Cancer Rehabilitation

Case Diagnosis: Recurrent metastatic Ewing sarcoma causing an intraparenchymal hemorrhage, leading to hemiparesis and aphasia.

Case Description: An 18-year-old male with a history of Ewing sarcoma of the pelvis experienced a right frontal lobe hemorrhage from a metastatic lesion. After an emergent craniectomy, he was admitted to inpatient rehab with significant left-sided weakness and aphasia. He was briefly transferred to a different facility for radiation treatment, where he also received Botox for spasticity and was fitted for orthotics. Following radiation, he was readmitted for a second rehab stay with a principal diagnosis of large intraparenchymal hemorrhage and right craniectomy. On his second admission, he had significant left-sided weakness and required moderate assistance for transfers and ambulation. After intensive therapy, his condition greatly improved. By discharge, his aphasia had nearly resolved, and he was independent with bed mobility, transfers, and walking. He was discharged home with his family for continued outpatient therapy.

Discussions: This case highlights the crucial role of a physiatrist in treating a young cancer patient with complex needs. The decision to transfer the patient for timely radiation therapy, coordinated with oncology and neurosurgery, was essential to address the underlying disease before intensive rehabilitation. The patient's rapid recovery demonstrates the remarkable neuroplasticity and potential for recovery in a motivated young individual. Proactive interventions like early Botox for spasticity also likely contributed to his excellent functional outcomes.

Conclusions: This case demonstrates the success of a comprehensive, coordinated cancer rehabilitation program. After a hemorrhagic stroke from a metastatic tumor, this 18-year-old patient achieved significant functional recovery through inpatient rehabilitation. He progressed from needing assistance to being functionally independent within a short period, showcasing the immense value of aggressive rehabilitation in cancer care. It underscores that the physiatrist is a key player who coordinates with other specialists to ensure timely treatment and optimal outcomes.