Background and Purpose: Herpes Simplex Encephalitis (HSE), the most common cause of sporadic viral encephalitis, causes permanent neurologic deficits and disablement in many affected individuals. To our knowledge, there have been no published studies that have examined any aspects of rehabilitation for individuals with HSE. The purpose of this case report was to investigate the effects of a physical therapist directed rehabilitation program to improve balance and gait in an individual with severe ataxia and imbalance secondary to HSE.  

Case Description: A 25-year-old male with acute vestibular neuritis and diffuse cerebellitis caused by HSE presented to an inpatient rehabilitation hospital with nystagmus, motion sensitivity, trunk tremoring, and balance and coordination problems that impaired his ability to transfer, walk, and perform his daily life activities.

Intervention: The individual participated in an intensive 17 day, six day per week physical therapy program, consisting of eye-head coordination and habituation exercises, balance training, and functional task practice.  

Outcomes: Outcome measures used were the Functional Independence Measure (FIM), Berg Balance Scale (BBS) and the Brief Ataxia Rating Scale (BARS). Improvements were noted in all outcome measures (pre to post); the patient progressed from a 0/56 to a 49/56 on the BBS and from an 18/30 to a 7/30 on the BARS. Improvements in sitting balance, transfers, and walking enabled the patient to return home with assistance from his parents for driving and some fine motor tasks.  

Discussion: Physical therapy may improve balance and mobility for patients with cerebellar and vestibular pathologies secondary to HSE.