Ann Rehabil Med.  2021 Dec;45(6):422-430. 10.5535/arm.21133.

Changes in Function and Muscle Strength of Encephalitis Survivors After Inpatient Rehabilitation

• Kim T
• Cheong IY

• KMID: 2523839
• DOI: http://doi.org/10.5535/arm.21133

Abstract

Objective
To investigate the clinical demographics and rehabilitative assessments of encephalitis survivors admitted to a rehabilitation center, and to confirm the effects of inpatient rehabilitation manifested by changes in muscle strength and function after hospitalization.
Methods
Data of encephalitis survivors who received rehabilitation at our institution from August 2009 to August 2019 were reviewed. Medical charts were retrospectively reviewed, and motor, functional, and cognitive assessments were collected. Manual muscle testing (MMT), Fugl-Meyer Assessment (FMA), Berg Balance Scale (BBS), Functional Ambulation Category (FAC), Korean version of Modified Barthel Index (K-MBI), grip strength, Box and Block Test (BBT), and Korean version of Mini-Mental State Examination (K-MMSE) were performed, and the results upon admission and discharge were compared and analyzed.
Results
Most of the patients with encephalitis admitted to our institution had viral or autoimmune etiologies. The assessment results of 18 encephalitis patients upon admission and discharge were compared. The total K-MBI score, FAC, grip strength, and BBT significantly improved, but not the MMT and FMA. Subgroup analysis was performed for viral and autoimmune encephalitis, which are the main causes of the disease, but there was no difference in items with significant changes before and after hospitalization.
Conclusion
Encephalitis survivors showed a significant improvement in functional assessment scale during their hospital stay through rehabilitation, without significant changes in motor strength. Hence, we can conclude that encephalitis survivors benefit from inpatient rehabilitation, targeting functional gains in activities of daily living training more than motor strength.

Keyword

Encephalitis, Rehabilitation, Functional outcome

Figure

• 

  Fig. 1. Flow chart for the inclusion and/or exclusion of study participants. NRC, National Rehabilitation Center.

Reference

1. Granerod J, Ambrose HE, Davies NW, Clewley JP, Walsh AL, Morgan D, et al. Causes of encephalitis and differences in their clinical presentations in England: a multicentre, population-based prospective study. Lancet Infect Dis. 2010; 10:835–44.

2. Hasbun R, Rosenthal N, Balada-Llasat JM, Chung J, Duff S, Bozzette S, et al. Epidemiology of meningitis and encephalitis in the United States, 2011-2014. Clin Infect Dis. 2017; 65:359–63.

3. Hansen MA, Samannodi MS, Castelblanco RL, Hasbun R. Clinical epidemiology, risk factors, and outcomes of encephalitis in older adults. Clin Infect Dis. 2020; 70:2377–85.

4. Christie S, Chan V, Mollayeva T, Colantonio A. Systematic review of rehabilitation intervention outcomes of adult and paediatric patients with infectious encephalitis. BMJ Open. 2018; 8:e015928.

5. Modi S, Mahajan A, Dharaiya D, Varelas P, Mitsias P. Burden of herpes simplex virus encephalitis in the United States. J Neurol. 2017; 264:1204–8.

6. Titulaer MJ, McCracken L, Gabilondo I, Armangue T, Glaser C, Iizuka T, et al. Treatment and prognostic factors for long-term outcome in patients with antiNMDA receptor encephalitis: an observational cohort study. Lancet Neurol. 2013; 12:157–65.

7. Kneen R, Michael BD, Menson E, Mehta B, Easton A, Hemingway C, et al. Management of suspected viral encephalitis in children: Association of British Neurologists and British Paediatric Allergy, Immunology and Infection Group national guidelines. J Infect. 2012; 64:449–77.

8. Solomon T, Michael BD, Smith PE, Sanderson F, Davies NW, Hart IJ, et al. Management of suspected viral encephalitis in adults: Association of British Neurologists and British Infection Association National Guidelines. J Infect. 2012; 64:347–73.

9. Nakajima D, Yamamoto A, Kobayashi T, Osawa T, Shitara H, Ichinose T, et al. The effects of rotator cuff tears, including shoulders without pain, on activities of daily living in the general population. J Orthop Sci. 2012; 17:136–40.

10. Han TR, Bang MS, Chung SG. Rehabilitation medicine. 6th ed. Seoul, Korea: Koonja Publishing Company;2019.

11. Ong HL, Abdin E, Chua BY, Zhang Y, Seow E, Vaingankar JA, et al. Hand-grip strength among older adults in Singapore: a comparison with international norms and associative factors. BMC Geriatr. 2017; 17:176.

12. Dodds RM, Syddall HE, Cooper R, Kuh D, Cooper C, Sayer AA. Global variation in grip strength: a systematic review and meta-analysis of normative data. Age Ageing. 2016; 45:209–16.

13. Rao N, Costa JL. Rehabilitation of three patients after treatment for herpes encephalitis. Am J Phys Med Rehabil. 1991; 70:73–5.

14. Bohannon RW. Correlation of lower limb strengths and other variables with standing performance in stroke patients. Physiother Can. 1989; 41:198–202.

15. Jorgensen HS, Nakayama H, Raaschou HO, Vive-Larsen J, Stoier M, Olsen TS. Outcome and time course of recovery in stroke. Part I: Outcome. The Copenhagen Stroke Study. Arch Phys Med Rehabil. 1995; 76:399–405.

16. Kelly-Hayes M, Wolf PA, Kase CS, Gresham GE, Kannel WB, D’Agostino RB. Time course of functional recovery after stroke: the Framingham study. J Neurol Rehabil. 1989; 3:65–70.

17. Moorthi S, Schneider WN, Dombovy ML. Rehabilitation outcomes in encephalitis: a retrospective study 1990-1997. Brain Inj. 1999; 13:139–46.

18. Misra UK, Kalita J. Seizures in Japanese encephalitis. J Neurol Sci. 2001; 190:57–60.

19. Solomon T, Dung NM, Kneen R, Thao le TT, Gainsborough M, Nisalak A, et al. Seizures and raised intracranial pressure in Vietnamese patients with Japanese encephalitis. Brain. 2002; 125(Pt 5):1084–93.

20. Spatola M, Dalmau J. Seizures and risk of epilepsy in autoimmune and other inflammatory encephalitis. Curr Opin Neurol. 2017; 30:345–53.

21. Tailor YI, Suskauer SJ, Sepeta LN, Ewen JB, Dematt EJ, Trovato MK, et al. Functional status of children with encephalitis in an inpatient rehabilitation setting: a case series. J Pediatr Rehabil Med. 2013; 6:163–73.

22. Yamamoto E, Izumi SI, Shimakura K, Sawatari M, Ishida A. Memory rehabilitation of an amnesic patient following limbic encephalitis and a role of family members: a case report. Tokai J Exp Clin Med. 2000; 25:173–81.

23. Berry E, Kapur N, Williams L, Hodges S, Watson P, Smyth G, et al. The use of a wearable camera, SenseCam, as a pictorial diary to improve autobiographical memory in a patient with limbic encephalitis: a preliminary report. Neuropsychol Rehabil. 2007; 17:582–601.

24. Parkin AJ, Hunkin NM, Squires EJ. Unlearning John Major: the use of errorless learning in the reacquisition of proper names following herpes simplex encephalitis. Cogn Neuropsychol. 1998; 15:361–75.

25. Dewar BK, Gracey F. “Am not was”: cognitive-behavioural therapy for adjustment and identity change following herpes simplex encephalitis. Neuropsychol Rehabil. 2007; 17:602–20.

26. Dewar BK, Wilson BA. Cognitive recovery from encephalitis lethargica. Brain Inj. 2005; 19:1285–91.