title: Physical therapist examination, evaluation, and intervention for a patient with West Nile virus paralysis.
abstract: OBJECTIVE
  The incidence of West Nile virus (WNV) has increased in the United States since 1999. A small percentage of people with WNV develop West Nile neuroinvasive disease (WNND) with encephalitis and flaccid paralysis. The purpose of this report is to describe the physical therapist management and outcomes for a patient with WNND and the therapist's efforts to use an evidence-based practice approach in the management of a patient with this disease.
  
  
  METHODS
  The patient was an active 55-year-old woman in excellent health who became acutely ill with asymmetrical lower-extremity weakness. The physical therapist reviewed the available literature, consulted with medical and physical therapist experts and the patient, and elected to use a poliovirus "period of recovery" approach combining intensive strengthening and monitoring of fatigue.
  
  
  RESULTS
  The patient progressed from an initial nonambulatory status to ambulation with a single-point cane at week 18 after onset of symptoms. She began to ambulate without an assistive device by week 20. The patient returned to work part-time by week 22 and full-time by week 43.
  
  
  CONCLUSIONS
  These outcomes demonstrate the recovery of a patient with WNND after an intensive strengthening program.
authors.affiliation: Department of Pediatrics, Baystate Medical Center, Springfield, MA, USA. Nancy.Miller@bhs.org
authors.forename: Nancy H
authors.initials: NH
authors.lastname: Miller
authors.forename: David J
authors.initials: DJ
authors.lastname: Miller
authors.forename: Joanna L
authors.initials: JL
authors.lastname: Goldberg
mesh_terms: D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008875:Middle Aged; D010264:Paraplegia / Q000534:rehabilitation* / Q000821:virology*; D026741:Physical Therapy Modalities; D020127:Recovery of Function; D014901:West Nile Fever / Q000150:complications / Q000175:diagnosis*