Skip to main content
AAPM&R 2025 Main banner
JFK
Final Program


Official Program
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
On Demand
On Demand
In-Person
In-Person
Livestream
Livestream
Invite Only
Invite Only
Ticketed
Ticketed
Coffee Break
Coffee Break
Meal
Meal
Reception
Reception
Rate ePoster

General Rehabilitation

HTLV-1–Associated Myelopathy: A Case Report of Lower Extremity Pain and Disability

Saturday, October 25, 2025
8:00 AM - 9:15 AM MT
Location: Kiosk 1

    Poster Presenter(s)

  • Stefan Hamaway, MD

    Resident Physician
    State University of New York (SUNY) Downstate Health Sciences Univ PM&R Program
    Old Westbury, New York

    • Co-Author(s)

  • HP

    Henna Purewal, Other

    Medical Student
    University of Rochester Medical Center
    Rochester, New York

  • GK

    Getahun Kifle, MD

    Asst. Prof
    SUNY Downstate
    Brooklyn, New York

  • SA

    Sanjeev Agarwal, MD

    Program Director
    SUNY Downstate Health Sciences University
    Brooklyn, New York

Disclosure(s):
Stefan Hamaway, MD: No financial relationships to disclose
Sanjeev Agarwal, MD: No financial relationships to disclose
Case Diagnosis: Rehabilitation and management of newly diagnosed HTLV-1 Associated Myelopathy.

Case Description or Program Description:

Case Presentation:  67-year-old female with recently diagnosed with HTLV-1 Associated Myelopathy (HAM) after recent inpatient admission 10 months prior with bilateral lower extremity neuropathy, numbness, abdominal band-like pain, urinary retention and constipation. Work-up included MRI brain which ruled out demyelinating disease and MRI total spine which ruled out a compressive myelopathy. Further evaluation with blood titers for non-compressive myelopathy was done, and patient was found to be HTLV-1 antibody positive. After discharge, patient was referred for outpatient physiatry evaluation. Initial outpatient physical exam findings included decreased bilateral lower extremity strength grossly 4/5 throughout and diffuse hyperreflexia. Gait was narrow-based with poor balance (unable to tandem walk), contact guard assist with straight cane.

Setting: Setting: Outpatient PM&R clinic

Assessment/Results: Assessment/

Results:  Patient was started on a course of physical therapy with a focus on lower extremity and lumbar strengthening and gait. On follow up 4 months later, bilateral lower extremity strength improved to 5/5 throughout, reflexes 2+ throughout, and gait improved with normal stride and intact balance no longer requiring straight cane. Decreased sensation persisted over bilateral lower extremities but neuropathy improved with gabapentin and Caribbean topical balm. She was now able to walk more than 1000 ft during her most recent PT session. She was given HEP to maintain her improved strength.

Discussion (relevance): HAM, also known as tropical spastic paraparesis, is characterized by progressive weakness and spasticity in the lower extremities, associated with back pain and bowel and bladder dysfunction. This case emphasizes the integral role of physiatry in reducing morbidity and improving functional status in HAM through PT and medication management to better tolerate therapy.

Conclusions: HAM is a a chronic progressive neurological disorder affecting the spinal cord that causes significant morbidity. A multidisciplinary team is crucial to improve patient function and quality of life.