Rehabilitation May Improve Significant Functional Declines in People with West Nile Neuro-Invasive Disease


Newswise — People with West Nile neuro-invasive disease, a severe and systemic illness caused by infection with the mosquito-borne West Nile virus, can have significant functional and cognitive declines and may benefit from individualized, brain injury-specific rehabilitation as a cornerstone of their recovery, according to a new study presented this week at the Association of Academic Physiatrists Annual Meeting in Puerto Rico.

While 80% of people infected with the West Nile virus (WNV) do not show any symptoms, some may experience severe neuro-invasive disease that can cause cognitive and functional impairments. To learn more about the impact of this disease on patients and what role rehabilitation should play in their recovery, physical medicine and rehabilitation physicians at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health in Long Island, NY conducted a retrospective chart review study of patients with severe West Nile neuro-invasive disease who were admitted to an acute inpatient brain injury rehabilitation facility from June to December, 2012.

“West Nile virus is the most common cause of epidemic viral encephalitis in the United States. In 2018, the Centers for Disease Control and Prevention (CDC) reported a little under 2,500 cases of West Nile virus in the United States, with approximately 62% of these individuals classified as neuro-invasive disease,” said Komal G. Patel, DO, the study’s co-author. “Even though some patients may remain asymptomatic, those that develop severe neuro-invasive disease have their day-to day lives significantly altered. Current treatments for West Nile virus are primarily supportive. As a medical specialty that focuses primarily on function and recovery, we wished to evaluate if the established program we have for individuals who suffer from brain injuries would be of benefit to this patient population.”

The five patients in this review received a comprehensive, brain injury specific rehabilitation program at an acute care facility. The patients’ ages ranged from 43 to 78 years old. These patients spent anywhere from 10 to 22 days in the acute medical hospital, with a mean length of stay in an acute hospital facility of 15 days. Their stay at the acute brain injury rehabilitation facility ranged from 14 to 21 days, with a mean length of stay of 17.8 days. During their acute rehabilitation course, researchers found their Functional Independence Measure (FIM) scores, which is an 18-item measure of a patient’s functional ability and need for assistance with certain tasks, at admission to range from 14 to 63, with a mean FIM score of 45.2. Higher scores on the FIM indicate less need of assistance by the patient. At discharge from the acute rehabilitation facility, the patients’ FIM scores ranged from 61 to 100, with a mean FIM score of 82.2. Their FIM score gains ranged from 23 to 60 points, with a mean score gain of 37, indicating that a course of acute inpatient brain injury rehabilitation may potentially be of benefit for recovery of functional independence in this patient population.

The patients’ Cognitive subcategory FIM score gains ranged from 1 to 18, with a mean cognitive gain of 7. Their Mobility subcategory FIM score gains ranged from 13 to 20, with a mean mobility gain of 17.4. Their Activities of Daily Living (ADL) subcategory FIM gains ranged from 4 to 23, with a mean ADL gain of 12.6. Of the five patients in the study, three were discharged to continue rehabilitative services at home, one was discharged to a skilled nursing facility, and one was discharged to an assisted living facility.

The study’s findings suggest that patients with West Nile neuro-invasive disease can have significant functional declines in all three of the key subcategories of functional independence: cognition, mobility and activities of daily living. The score improvements observed in the study show that a course of acute inpatient brain-injury rehabilitation may help this patient population improve their cognitive and functional outcomes.

“Given that the current medical arsenal we have to offer patients who are infected with the West Nile virus is limited, this finding that already established brain injury rehabilitation programs may be of benefit to help functional and cognitive recovery, may prove to further advance the medical care needed for these individuals,” said Dr. Patel. “We hope that this study will allow individuals infected with West Nile virus, particularly of the neuro-invasive type, to gain more access to acute inpatient rehabilitation facilities, and allow physical medicine and rehabilitation physicians to help individualize rehabilitation programs for these patients with a goal to send them back home in a safe fashion.”

 

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The Association of Academic Physiatrists (AAP) is a professional society with a mission to create the future of academic physiatry through mentorship, leadership, and discovery. The only academic association dedicated to the specialty of physiatry, its members are leading physicians, researchers, in-training physiatrists, and professionals in 21 countries and 44 U.S. states. With a keen focus on research and education, the AAP holds an Annual Meeting, produces a leading medical journal in rehabilitation: AJPM&R, and leads a variety of programs and activities that support and enhance academic physiatry. To learn more about the Association and specialty of physiatry, visit physiatry.org and follow us on Twitter at @AAPhysiatrists.

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