An Inpatient Rehabilitation Perspective on Neuromyelitis Optica: Case Report

Abstract

Background and Purpose: This case examines the inpatient rehabilitation experience of an African American male with Neuromyelitis Optica Spectrum Disorder (NMO).

Case Description: The patient was a 34-year-old African American male with acute onset NMO with a unique presentation that affected his left visual field, left upper and lower extremity.

Intervention: The patient received rehabilitation according to his physical impairments. During his 16-day stay, the patient received a total of 2345 minutes of rehabilitation involving physical and occupational therapy. This patient did not require speech therapy services. Treatments included functional mobility training, gait training, activities of daily living training, strength and endurance training, orthotics, kinesiotaping, dry needling and neuromuscular reeducation.

Outcomes: Functional mobility and activities of daily living performance for physical and occupational therapy were assessed using the Inpatient Rehabilitation Patient Assessment Instrument per Centers for Medicare and Medicaid Services standards. Improvements in bed mobility, transfers, gait, upper and lower body dressing, selfcare, range of motion, strength, endurance, and overall functional mobility were observed. The participant was able to safely return home and begin outpatient physical therapy following discharge.

Discussion: This case analyzes the clinical presentation and course of inpatient rehabilitation in a young male with NMO. This case supports the use of individualized multidisciplinary therapeutic services in the rehabilitation of NMO. The outcomes in this case support further investigation for physical rehabilitation in NMO patients.

Introduction

Neuromyelitis Optica Spectrum Disorder (NMO) is a rare neurological disease commonly mis-diagnosed as Multiple Sclerosis (MS) (Lalan et al., 2012). Patients typically present with central spinal cord lesions resulting in bilateral (B) vision loss and paralysis to the arms or legs and even the face. NMO is most prevalent in females as well as Asian, Black and Indian populations (Pereira et al., 2020;Hor et al., 2020). In the United States, the average age of onset is 41.1 years (Mealy et al., 2012). The 2015 international diagnostic criteria for NMO are summarized in Table 1 (Wingerchuk et al., 2015). The six listed core clinical characteristics involve 1 of 6 central nervous system regions: optic nerve, spinal cord, area postrema of dorsal medulla, brainstem, diencephalon, or cerebrum respectively (Wingerchuk et al., 2015).

NMO can lead to severe disability. Disability is typically relapse related and treated aggressively to prevent permanent impairment.6 As with any neurological disease, physical rehabilitation is a key component in reducing disability and improving overall functional mobility. However, due to its low incidence, few studies address physical rehabilitation in patients with NMO. Rehabilitation services are generally based around MS protocols; however, efficacy is unknown. The limited research available suggests that a multidisciplinary rehabilitation program may lead to functional and neurological improvements in NMO patients.7–9 This case report outlines the inpatient rehabilitation (IRF) course of a 34-year-old African American male with NMO. This report conforms to all CARE guidelines.10 This report did not require Institutional Review Board approval. Written consent was obtained from the patient. The authors have no funding or conflicts of interest to disclose.