Disclosures: Branden J. King, DO: No financial relationships or conflicts of interest

Case Diagnosis: Recovery of a 13 year old male in a minimally conscious state (MCS) secondary to anti-NMDA receptor encephalitis in a specialized pediatric rehabilitation program for patients with disorders of consciousness.

Case Description: Acute Course: Patient was a previously healthy 13-year-old male who initially presented with headaches that progressed over the course of a month to numbness and tingling in extremities. Found to have subclinical seizures which progressed to status epilepticus and diagnosed with anti-NMDA receptor encephalitis. Patient required high-dose anti-epileptics and aggressive immunosuppression. As anti-epileptics were weaned, patient remained in a MCS. Rehabilitation Course: Due to functional status, patient admitted to a 4-week, multi-disciplinary Minimally Aware Program (MAP) with goal of IRF trial and family training. JFK Coma Recovery Scale-Revised (CRS-R) documented throughout MAP stay. Wee-FIM scores documented in following two months at IRF and subsequent 1-month acute hospital stay for decannulation. Patient progressed to and remains enrolled in outpatient therapies.

Setting: Pediatric acute inpatient rehabilitation hospitalAssessment/

Results: Initial CRS-R (0-20 points) 5 and improved to 13 at time of discharge from MAP. Patient was able to transition from MAP to traditional IRF 4 weeks s/p admission to MAP. Wee-FIM (1-7 points) scores recorded at time of discharge to IRF, acute hospital, and home. Sit-to-stand transfers were 1, 2, 4, respectively. Upper body dressing scores were 1, 4, 5, respectively.

Discussion: Patient qualified for MAP due to severity of anti-NMDA receptor encephalitis. Patient emerged from minimally conscious state and advanced to traditional IRF. Recovery continued at IRF for two months. Patient returned to acute hospital for decannulation and continued therapies. He was discharged to outpatient therapies

Conclusion: MAP provides a potential pathway to IRF for patients who do not functionally qualify for IRF and may otherwise be lost to follow-up. Anti-NMDA receptor encephalitis is a rare condition in which patients may benefit from MAP.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/minimally-aware-program-for-inpatient-rehabilitation-of-pediatric-patient-with-anti-nmda-receptor-encephalitis/