P93: Neuro-Rehabilitation in a Pediatric Stroke Patient Supported on a CentriMag Right Ventricular Assist Device: A Case Report

Abstract

Introduction: With strokes being one of the most common and morbid ventricular assist device (VAD) complications, the need for physical rehabilitation dramatically increases when a patient on a VAD suffers neurological injury. Patients with severe neurological deficits require intense rehabilitation that includes base of support challenges, utilization of dynamic surfaces, and positions in prone, kneeling, or quadruped for neuro-motor re-education. Neuro-rehabilitation can be challenged by short cannulas, an external motor, a large interface, and a confining intensive care unit admission at our institution when a patient is supported on a CentriMag device. Case Description: The patient is a 10-year-old male diagnosed with Ebstein’s anomaly, on a CentriMag RVAD as a bridge to cardiac transplant who sustained a massive right middle cerebral artery stroke requiring hemicraniectomy. The patient presented with dense left hemiparesis and multi-system impairments such as vision, vestibular, and proprioception deficits which required intensive neuro-rehabilitation treatment. Given the challenges of being on the Centrimag device, therapy treatments required a multi-disciplinary team and strategies such as removing the CentriMag motor from the bracket to minimize cannula tension and risk of dislodgement to allow greater degree of movements without causing disruption to flow and cannula stability. The patient completed 101 sessions progressing from dependent for all mobility to ambulating 20 ft with a hemi-walker prior to his transplant. Treatment interventions included usage of dynamic surfaces, tilt table, and partial weight bearing gait trainers. Discussion: While ICU mobility progression from bed mobility to ambulation have been reported, intense neuro-rehabilitation requiring high frequency and complex mobility is not readily described. This case suggests that implementing progressive mobility and intensive neurological rehabilitation can be safe and feasible with a trained multidisciplinary team for pediatric patients on a CentriMag.