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Management of Bilateral Complex Regional Pain Syndrome in a Pediatric Patient

Purpose: To describe the physical therapy management of a pediatric patient with bilateral lower extremity complex regional pain syndrome (CRPS). Case Description: The participant was a 13-year-old adolescent girl who was admitted to an inpatient rehabilitation unit with bilateral lower extremity CRPS-I. Examination included assessment of lower extremity active range of motion, transfers, mobility, and completion of the Functional Independence Measure for Children (WeeFIM). Intervention consisted of gradual desensitization techniques, progressive weight bearing and mobility, functional transfer training, progressive strengthening, and cardiovascular exercises—all conducted using a modified pain exposure therapy approach. Outcome: WeeFIM scores increased to modified independence or independent in all areas. Discussion: The severity of the patient's CRPS necessitated a progressive and function-based approach to physical therapy management. Motivation, a pain exposure-based approach, and a multidisciplinary team approach appeared to affect the participant's recovery of function and reintegration into school and leisure activities.