200 Section - Functional Improvement Following Robot-Assisted Gait Training in a Pediatric Amputee with Congestive Heart Failure and Critical Illness Polyneuropathy: A Case Report

Case Diagnosis: Critical illness polyneuropathy and below-knee amputation from prolonged ICU stay in a pediatric patient with known congestive heart failure from rheumatic heart disease.

Case Description: A 13-year-old girl with rheumatic heart disease developed congestive heart failure, sepsis, and acute limb ischemia requiring left below-knee amputation during a 111-day ICU stay. She was discharged with severe bilateral limb weakness, poor trunk control, and complete functional dependence. Ten months post-discharge, she was admitted for intensive inpatient rehabilitation. Diagnostic workup included normal brain and spine MRI, normal creatine kinase levels, and electrodiagnostic studies showing symmetric sensorimotor polyneuropathy with acute and chronic denervation changes. The rehabilitation program consisted of daily physical and occupational therapy, with robot-assisted gait training (RAGT) added to enhance mobility and endurance. After the intervention, the patient showed significant gains in strength, trunk control, mobility, and functional independence. She also demonstrated improved hand function, reduced fatigue, and better overall physical and psychosocial well-being. No adverse events were noted during the course of treatment.

Discussions: This case highlights the potential of RAGT as an effective adjunct to conventional rehabilitation in a medically complex pediatric patient. Despite the delayed initiation of therapy, substantial gains were observed across multiple functional domains. RAGT provided high-repetition, task-specific training that likely contributed to neuromuscular re-education, improved trunk activation, and enhanced endurance. While RAGT has been widely studied in adult stroke and spinal cord injury populations, its application in pediatric patients with multisystem impairments such as heart failure and polyneuropathy remains limited. This report contributes to the growing evidence supporting technology-assisted rehabilitation in complex pediatric cases.

Conclusions: RAGT may be a safe and feasible intervention in pediatric patients with critical illness polyneuropathy and heart failure. Further studies are needed to evaluate long-term outcomes and broader applicability.