Physical Therapy Interventions and Outcomes for a Patient Diagnosed with Anti-NMDA-Receptor Encephalitis: A Retrospective Case Report

Background: Anti- N-methyl-D-aspartate (NMDA) receptor encephalitis is the second most common cause of autoimmune encephalitis after acute demyelinating encephalitis. Patients often present with acute behavioral changes, psychosis, and abnormal limb movements. Alternatively, they can also present with symptoms of catatonia. Treatment for anti-NMDA receptor encephalitis typically consists of an immunotherapy protocol consisting of IVIG, steroids, and plasmapheresis, with more aggressive therapy being reserved for sever or refractory disease. This retrospective case report describes the medical treatment, physical therapy interventions, and outcomes of a 16-year-old patient diagnosed with anti-NMDA receptor encephalitis with malignant catatonia in the acute inpatient hospital setting. Outcomes: She had 26 physical therapy sessions which incorporated interventions such as training in bed mobility, transfer, gait, functional strengthening, balance re-education, and dual task activities. With these therapeutic modalities combined with electroconvulsive therapy (ECT), she progressed to a supervision level for mobility tasks. Her score on the Bush Francis Catatonia Rating Scale improved from 27 to 9, her score on the Boston AM-PAC improved from 11 to 23 and her score on the Pediatric Balance Scale improved from 24 to 45. Initial interventions including bed mobility, transfer, and gait training, as well as, parent education and later included balance re-education and age appropriate functional tasks such as throwing, kicking, obstacle courses, and ambulation outdoors. Ultimately, the patient was able to progress to completing mobility tasks with supervision. Discussion: The addition of ECT to the PT interventions was important, as it improved the patient’s ability to actively participate in PT sessions. She demonstrated consistent progress towards meeting her PT goals which facilitated her discharge home with her family with continued PT treatment in the outpatient setting