Encephalitis: Causes, Symptoms & Physiotherapy Treatment | Arunalaya post thumbnail image

Encephalitis

Encephalitis treatment at Arunalaya
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What Is Encephalitis?

Encephalitis is a serious medical condition characterized by inflammation of the brain. This inflammation can lead to a wide range of neurological symptoms and, in severe cases, can be life-threatening or cause permanent brain damage.

Causes of Encephalitis

Encephalitis can be broadly categorized into two main types based on their cause:

  •  Infectious Encephalitis: This is the most common type and occurs when an infection (usually viral) directly invades the brain.
  •  Viruses: The most frequent culprits. Common viral causes include:
  •  Herpes simplex viruses (HSV): Both HSV-1 (causes cold sores) and HSV-2 (causes genital herpes) can cause encephalitis. HSV-1 is a common cause of severe encephalitis.
  •  Other herpes viruses: Epstein-Barr virus (mononucleosis), varicella-zoster virus (chickenpox and shingles).
  •  Enteroviruses: Such as poliovirus and coxsackievirus, often causing flu-like symptoms.
  •  Arboviruses (mosquito-borne and tick-borne viruses): These include West Nile virus, La Crosse virus, St. Louis encephalitis virus, Eastern equine encephalitis virus, Western equine encephalitis virus, and Powassan virus.
  •  Rabies virus: Transmitted by infected animal bites, leading to rapidly progressive encephalitis.
  •  Measles, mumps, and rubella viruses: Though less common now due to widespread vaccination.
  •  Bacteria, Fungi, and Parasites: While less common than viral causes, these microorganisms can also lead to encephalitis in rare cases. Examples include bacteria causing meningitis (which can spread to the brain), certain fungi, and parasites like Toxoplasma gondii.
  •  Autoimmune Encephalitis: This occurs when the body’s own immune system mistakenly attacks healthy brain cells, causing inflammation. This can be triggered by:
  •  Previous infections: A reaction to an infection in another part of the body that occurred weeks earlier (known as “post-infectious encephalitis” or acute disseminated encephalomyelitis – ADEM).
  •  Cancerous or non-cancerous growths (tumors): The immune response to the tumor can sometimes cross-react with brain tissue.
  •  Vaccinations: In very rare cases, a vaccine can trigger an autoimmune response leading to encephalitis.
  •  Unknown causes: Sometimes, the reason for the immune system attacking the brain remains unclear.
Symptoms of Encephalitis

The symptoms of encephalitis can vary widely depending on the severity of the inflammation, the part of the brain affected, and the person’s age. They can develop rapidly over hours or days, or more slowly over weeks.

Common initial symptoms (often flu-like):

  •  Fever (high temperature)
  •  Headache (ranging from mild to severe)
  •  Body aches
  •  Fatigue/tiredness
  •  Poor appetite
  •  General feeling of being unwell

More serious and specific neurological symptoms that can develop:

  •  Confusion or disorientation: Difficulty thinking clearly, knowing where they are, or who they are.
  •  Changes in personality and behavior: Irritability, agitation, hallucinations, psychosis, uncharacteristic behavior.
  •  Seizures or fits: Involuntary muscle twitching, convulsions, or loss of consciousness.
  •  Difficulty speaking (aphasia) or understanding speech.
  •  Weakness or loss of movement in parts of the body: This can affect one side of the body (hemiparesis) or all four limbs (tetraparesis).
  •  Loss of consciousness or drowsiness: Ranging from lethargy to coma.
  •  Stiff neck: Similar to meningitis, indicating irritation of the meninges (membranes surrounding the brain and spinal cord).
  •  Sensitivity to light (photophobia) or sound (phonophobia).
  •  Nausea and vomiting
  •  Movement disorders: Tremors, problems with coordination (ataxia).
  •  Memory loss (amnesia): This can be significant and long-lasting.

In infants and young children, symptoms can be more subtle:

 Bulging soft spot (fontanelle) on the head

  •  Body stiffness
  •  Irritability
  •  Poor feeding
  •  Crying that would not stop or worsens when handled
Advanced Physiotherapy for Encephalitis

Detailed evaluation of muscle strength, tone (spasticity or hypotonia), sensation, reflexes, balance, coordination, and posture.

  •  Assessment of functional mobility: rolling, sitting, standing, walking, transfers, and activities of daily living (ADLs).
  •  Evaluation of respiratory function, especially if there’s involvement of breathing muscles.
  •  Assessment of cognitive function (attention, memory, problem-solving) and how it impacts movement and learning.
  •  Goal setting in collaboration with the patient and family (short-term and long-term goals).
Motor Retraining and Strengthening

Neuro-facilitation techniques (e.g., Bobath concept, PNF – Proprioceptive Neuromuscular Facilitation): To encourage and retrain normal movement patterns, reduce abnormal tone (spasticity), and improve muscle control.

  • Task-specific training: Practicing real-life activities that are meaningful to the patient (e.g., reaching for objects, stepping over obstacles, getting dressed).
  • Strengthening exercises: Graded exercises for all affected limbs and trunk muscles, using body weight, resistance bands, weights, or specialized equipment. This helps combat muscle weakness and atrophy.
  • Range of motion exercises: Passive, active-assisted, and active exercises to prevent joint stiffness (contractures) and maintain flexibility.
Balance and Coordination Training
  • Static and dynamic balance exercises: Progressing from sitting balance to standing balance, and then to dynamic activities like walking on uneven surfaces or reaching outside the base of support.
  • Coordination drills: Exercises to improve the precision and smoothness of movements, which can be affected by cerebellar involvement.
  • Gait training: Addressing abnormal walking patterns, improving walking speed, endurance, and safety. This may involve using assistive devices (walkers, crutches, canes) initially and progressing to independent walking.
Mobility and Functional Independence
  • Transfers training: Practicing moving between different surfaces (bed to chair, chair to toilet, etc.).
  • Bed mobility: Learning to roll, change positions, and get in/out of bed.
  • Stair climbing: Gradually reintroducing stair negotiation.
  • Falls prevention strategies: Education on environmental modifications, safe movement, and recognition of risk factors
Sensory Integration

Addressing sensory deficits (e.g., numbness, altered sensation) through sensory stimulation techniques to improve awareness and motor control.

  •  Respiratory Physiotherapy (if needed):
  •  Breathing exercises to improve lung capacity and efficiency.
  •  Secretion clearance techniques if there’s difficulty managing respiratory secretions.
Cognitive-Motor Integration
  • Designing exercises that challenge both physical and cognitive abilities simultaneously (e.g., dual-task training) to improve overall functional performance.
Assistive Devices and Orthotics
  • Assessment and prescription of appropriate walking aids, wheelchairs, splints, or braces (orthotics) to support weak limbs, prevent deformities, and improve function.

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