Rehabilitation Program
Physical Therapy
Brain injury from West Nile virus encephalitis or meningitis can result in cognitive, gross motor, and fine motor delays. Because infected patients have varying degrees of functional deficits, treatment programs must be individualized. Comprehensive rehabilitation using a team consisting of a physiatrist, nurse, physical therapist, occupational therapist, speech therapist, social worker/case manager, and neuropsychologist achieves best outcomes.
The physical therapist can partially address the problems of increased muscle tone, weakness, decreased sensation, and poor endurance. Mobility training, transfer training, and gait training are usually implemented, with range of motion and proper positioning attended to as well. Physical therapists are also important in providing exercises for muscle reeducation and for the improvement of strength, endurance, coordination, and balance, with the goal of returning the patient to independent function.
Occupational Therapy
Occupational therapy focuses on the activities of daily living (ADLs), including bathing, dressing, feeding, and hygiene maintenance. Occupational therapists provide a program to maximize the use of the arms and hands with functional activities; they also address the cognitive issues that affect daily independent function. (See also Further Outpatient Care.)
Speech Therapy
Patients may develop dysarthria, dysphagia, or aphasia. A structured speech therapy program may improve their ability to swallow, help them recover speech and language function, and prevent complications, such as aspiration pneumonia. (See also Further Outpatient Care.)
Medical Issues/Complications
Pressure ulcers
The development and progression of a pressure ulcer can deeply affect the type, length, and cost of a patient's rehabilitation. Pressure ulcers are caused by prolonged pressure, shear forces, friction, and maceration.
Means of preventing this complication include close monitoring of potential ulcer sites, frequent repositioning to reduce pressure on vulnerable areas, ensuring that adequate nutrition is provided, and cleaning and drying sites of perspiration, urine, or feces.
Once a pressure ulcer develops and progresses, more severe complications (eg, wound infection, bacteremia, osteomyelitis) may enter the clinical picture.
Deep venous thrombosis
Elderly patients who are severely deconditioned because of West Nile virus encephalitis may be predisposed to deep venous thrombosis (DVT). The inherent risk of having DVT is the development of a pulmonary embolus that can cause death.
Risk factors for DVT may include, among others, decreased mobilization, a history of smoking, and a history of premorbid medical conditions, such as coronary artery disease, diabetes mellitus, hypercoagulopathy, and peripheral vascular disease.
Prevention strategies include the use of thigh-high compression stockings, pneumatic compression devices, and subcutaneous, unfractionated or low–molecular weight heparins. Early mobilization and ambulation also may decrease the risk of DVT.
Doppler ultrasonography may be used to monitor for DVT, but its accuracy is limited, as has been shown in many studies.
Pulmonary complications
Individuals with severe illness secondary to West Nile virus infection are at increased risk of pulmonary complications in the rehabilitation setting. Individuals with encephalitis may have a decreased level of consciousness, or they may suffer from dysphagia related to their neurologic injury, predisposing them to aspiration pneumonia.
Swallow evaluation can be performed to identify the problem and to help in implementing the appropriate diet and feeding techniques to decrease the risk of aspiration.
Phrenic nerve palsy has been described. This complication could lead to decreased expansion of the lungs, further increasing the risk of atelectasis and nosocomial pneumonia.
Deep-breathing exercises, use of an inspiratory spirometer, and early mobilization and ambulation help to decrease the risk of these complications occurring.
Other
A study by Greco et al suggested that West Nile virus infection could, in predisposed persons, contribute to the development of myasthenia gravis. In a study of 29 patients with myasthenia gravis, the investigators found that 17% of subjects demonstrated anti–West Nile virus immunoglobulin G (IgG), although none of the patients apparently had clinical signs or symptoms of the virus. [33]
Surgical Intervention
No surgical indications are reported at this time.
Consultations
See the list below:
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Physiatrist (physical medicine and rehabilitation specialist)
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Neurologist
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Infectious disease specialist
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Psychologist or neuropsychologist
