An Integrated Approach Using Physical Therapy and Therapeutic Lenses to Treat Post Encephalitis Syndrome and Lupus

Background and Purpose: This case report documents the use of physical therapy, primitive reflex integration and neuro-optometric interventions for AM, a 38-year-old, left-handed female, with flu-like signs and symptoms with cognitive changes over a 5-month period. AM had a sudden onset of chorea, headache, blurred vision, light sensitivity, loss of smell, sensation, strength, and coordination. Diagnostic tests and imaging studies suggested the diagnoses of Post Encephalitis Syndrome, Lupus, and Autoimmune Encephalitis. Case Description: With a noxious stimulus present, such as noise, AM exhibited dystonic movements, hyperkinetic gait, an extensor synergy in the left lower extremity and a flexor synergy in the right upper extremity. Symptoms resolved immediately with removal of noxious stimulus. AM’s symptoms also suggested bilateral cerebellar involvement. Methods: Primary impairments included sensorimotor deficits including decreased cervical muscle and core strength, presence of primitive reflexes, balance dysfunction and incoordination. Therefore, the physical therapy plan of care incorporated Rhythmic Movement Training, primitive reflex integration exercises, cervical muscle and core strengthening as well as high-level balance, coordination and agility training. Following neuro-optometric testing, retinal neuromodulation and mapping techniques, AM received various therapeutic lenses that improved quality of movement when presented with noxious stimuli. Results: Following therapy techniques and use of various therapeutic lenses, AM exhibited improved coordination and times on PT standardized tests, the absence of dystonic movement with noxious stimuli, improved recruitment of muscles during surface electromyography studies and improved coherence in the quantitative electroencephalogram measures. Conclusion: This retrospective case study demonstrates an interdisciplinary approach to address sensorimotor processing impairments linked to Post Encephalitis Syndrome with autoimmune infirmities. It also highlights the importance of evaluation for the presence and integration of primitive reflexes following adult brain injury and the benefit of neuro- optometry to facilitate improved coordination and processing of visual, sensorimotor, and auditory information. KEY WORDS: Vestibular, Retinal Neuromodulation, Post Encephalitis Syndrome, Lupus, Sensorineural Dysfunction, Neuro-Optometry, Physical Therapy, Primitive reflexes.