Physical Therapy for Motor and Functional Recovery After Encephalitis: A Narrative Review and Conceptual Rehabilitation Framework

Irina Karaganova ^* , Stefka Mindova

1. Department of Public Health, Faculty of Public Health and Health Care, University of Ruse “Angel Kanchev”, 97, Alexandrovska str. 7004, Ruse, Bulgaria

* Correspondence: Irina Karaganova 

Academic Editor: Giacomo Farì

Received: October 28, 2025 | Accepted: October 18, 2026 | Published: October 23, 2026

OBM Neurobiology 2026, Volume 10, Issue 4, doi:10.21926/obm.neurobiol.2604356

Recommended citation: Karaganova I, Mindova S. Physical Therapy for Motor and Functional Recovery After Encephalitis: A Narrative Review and Conceptual Rehabilitation Framework. OBM Neurobiology 2026; 10(4): 356; doi:10.21926/obm.neurobiol.2604356.

© 2026 by the authors. This is an open access article distributed under the conditions of the Creative Commons by Attribution License, which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is correctly cited.

1. Introduction

Encephalitis, an inflammatory condition of the brain parenchyma, can be infectious (viral or bacterial) or autoimmune in origin. Its clinical spectrum ranges from mild cognitive or behavioral changes to severe, persistent neurological deficits, including paresis, ataxia, aphasia, and long-term functional disability [1]. Epidemiological data indicate that infectious encephalitis occurs in approximately 1.4 to 13.8 cases per 100,000 people annually, with post-infectious sequelae leading to long-term disability in up to 40% of survivors [2].

Pathologically, encephalitis affects both grey and white matter and may spread from focal to diffuse brain regions, including subcortical structures and the brainstem. The resulting combination of inflammation, neuronal loss, demyelination, and secondary changes (such as edema, gliosis, and synaptic reorganization) disrupts motor and sensory pathways, corticospinal tracts, basal ganglia circuits, and cerebellar networks. Clinical manifestations may include hemiparesis or tetraparesis, altered muscle tone, impaired coordination and balance, ataxia, tremor, and limited gait capacity. Patients may also present with cognitive and behavioral disturbances that limit their therapeutic participation. These manifestations necessitate an individualized, phase-specific therapeutic approach [3].

Rehabilitation after encephalitis is a multifaceted process addressing neurological, cognitive, communicative, behavioral, and movement-related limitations [4,5]. Physical therapy specifically targets movement, motor control, strength, balance, gait, endurance, and postural control, while rehabilitation denotes the broader multidisciplinary process. Physical therapy may also help reduce secondary complications such as contractures, pressure injuries, and deconditioning. Cohort and case-based evidence, together with mechanistic literature on exercise-related neuroplasticity, provides the clinical rationale for these interventions [6,7,8,9].

Yet, despite increasing attention, there is still no widely accepted international guideline for rehabilitation specifically designed for encephalitis. Thus, many rehabilitation programs borrow principles from stroke and traumatic brain injury rehabilitation models [3], which may not fully reflect the unique pathophysiology, variability in recovery, and multisystem sequelae of encephalitis.

Contemporary literature, including systematic reviews, cohort studies, case series, and case reports, suggests a role for early, multidisciplinary, and individualized rehabilitation adapted to disease phase and patient-specific limitations [4,5]. Recovery can be prolonged, and long-term cognitive and functional sequelae have been documented after anti-NMDAR and other forms of encephalitis [1,4]. Neuroinvasive viral diseases such as West Nile neuroinvasive disease may involve substantial motor, functional, swallowing, and respiratory limitations, highlighting the need for multidisciplinary rehabilitation [10,11].

Rehabilitation after encephalitis remains less extensively studied than rehabilitation after other acquired brain injuries. The principal gap is not simply the scarcity of randomized evidence, but the absence of a transparent clinical structure that links heterogeneous published interventions to recovery phase, functional targets, individual phenotype, safety considerations, and multidisciplinary planning.

The aim of this narrative review is therefore to synthesize the available literature on physical therapy after encephalitis and translate recurring rehabilitation principles into a flexible conceptual framework for motor and functional recovery.

The framework represents the principal translational contribution of this article. It supports the Individual Rehabilitation Project (IRP), a person-centered rehabilitation management plan developed with the patient or proxy by an interdisciplinary team under the leadership of a Physical and Rehabilitation Medicine physician, as described in the UEMS-PRM European framework [12]. It is not a uniform treatment algorithm, a clinical trial, or a clinically validated protocol.

Beyond clinical intervention studies, broader methodological, clinical, and contextual literature provides important background rationale for brain injury and encephalitis outcomes. Systematic review protocols [13] and epidemiological or outcome studies [14] highlight long-term neurological sequelae, while medical management frameworks address specific acute complications such as anti-seizure protocols [15]. Additionally, exercise mechanisms studied in other acquired brain injury models [16] and individual pediatric case reports in related neuroinflammatory conditions such as acute disseminated encephalomyelitis [17] offer complementary insights into neuroplasticity and recovery mechanisms, supporting the need for structured rehabilitation frameworks. We did not include these publications in the clinical physical therapy evidence synthesis but retained them as contextual sources to inform the background and rationale for the proposed rehabilitation framework.

2. Materials and Methods

This work was conducted as a narrative literature review informing the development of a conceptual rehabilitation framework. We selected a narrative design to map a clinically and methodologically heterogeneous evidence base and to support transparent translation of reported interventions into a phase-specific clinical structure. No clinical intervention, pilot implementation, or prospective effectiveness evaluation was conducted as part of this study.

2.1 Literature Search and Eligibility Criteria

PubMed, Scopus, and Web of Science were searched for publications from January 2010 to October 2025. Search strings combined (encephalitis OR autoimmune encephalitis OR infectious encephalitis OR postinfectious encephalitis) AND (physical therapy OR physiotherapy OR rehabilitation) AND (motor recovery OR functional outcome OR gait OR balance OR task-oriented training OR neuroplasticity). We also screened reference lists of relevant publications. The search was intended for narrative synthesis and was not registered as a systematic-review protocol.

Inclusion criteria:

1. Randomized controlled trials and non-randomized clinical studies evaluating physical therapy or multidisciplinary rehabilitation in patients with infectious, autoimmune, or postinfectious encephalitis.
2. Observational cohort studies, case series, and case reports describing relevant rehabilitation interventions.
3. English-language peer-reviewed publications reporting measurable motor, mobility, activities-of-daily-living, or other relevant functional outcomes.

Exclusion criteria:

1. Animal or preclinical studies.
2. Reviews, protocols, epidemiological or prognostic publications, and publications focused exclusively on pharmacological or medical management were excluded from the clinical physical therapy evidence set; when relevant, they were retained separately as contextual sources for background or framework rationale.
3. Publications without a relevant measurable motor or functional outcome.
4. Reports lacking sufficient information to characterize the rehabilitation intervention or its functional context; reports concerning encephalopathy rather than encephalitis; conference abstracts; and reports whose primary focus was cognitive rehabilitation, dysphagia/swallowing rehabilitation, or general clinical outcomes without a sufficiently characterized physical therapy intervention.

The literature selection process is presented in an adapted PRISMA-style flow diagram for transparency (Figure 1). Because this study is a narrative literature review rather than a registered systematic review, the diagram summarizes the identification and eligibility assessment of relevant publications without implying a formal systematic-review protocol. A total of 46 relevant publications were considered during the literature synthesis based on database searching and reference list screening. We then assessed publications against the explicitly defined eligibility criteria. Following this screening, 18 reports constituted the final clinical physical therapy evidence set (4 cohort studies, 4 case series, and 10 case reports). Publications not meeting the clinical physical therapy eligibility criteria were excluded from the intervention evidence set; relevant reviews, protocols, epidemiological/prognostic studies, outcome-only reports, and broader neurorehabilitation publications were retained separately as contextual sources where appropriate. The flow diagram accounts for all 46 publications by distinguishing the 18 reports included in the clinical physical therapy evidence set from the 28 publications not included in that evidence set.

Figure 1 Adapted PRISMA-style flow diagram of literature identification, eligibility assessment, and clinical physical therapy evidence selection.

Because this was a narrative review, formal risk-of-bias and GRADE assessments were not undertaken. Clinical reports were distinguished from contextual sources and characterized qualitatively by design, sample, population, intervention, outcomes, and limitations. Although formal risk-of-bias tools were not applied, the qualitative limitations and uncontrolled nature of the included observational evidence are explicitly noted.

2.2 Data Extraction and Descriptive Synthesis

For each eligible publication, the authors extracted and descriptively organized the following information:

1. study design, sample size, and pediatric or adult population;
2. encephalitis etiology and clinical phenotype;
3. rehabilitation phase, intervention type, dosage, and multidisciplinary context;
4. motor, mobility, activities-of-daily-living, cognitive-motor, participation, and other reported outcomes;
5. follow-up duration, reported safety issues, and methodological limitations.

Findings were synthesized descriptively. Quantitative pooling was not performed because patient characteristics, etiologies, intervention content and dosage, outcome measures, and follow-up periods were substantially heterogeneous. Where individual studies reported numerical changes in validated measures, these were retained at study level rather than combined across clinically dissimilar reports.

2.3 Development of the Conceptual Rehabilitation Framework

The conceptual development pathway was: literature identification → descriptive evidence synthesis → identification of recurring rehabilitation principles → phase-specific organization of interventions → integration of patient-specific and multidisciplinary considerations → formulation of the conceptual rehabilitation framework.

The framework links each reported intervention to a functional target, recovery phase, evidence source, and clinical rationale. Neuroplasticity, task-specific practice, graded progression, safety monitoring, and participation were used as organizing principles. These principles informed clinical recommendations but were not treated as proof of intervention efficacy.

1. The resulting framework was designed to inform the IRP and to be adapted to etiology, age, neurological presentation, cognitive and behavioral impairment, seizure history, fatigue, autonomic or cardiorespiratory limitations, premorbid function, complications, rehabilitation potential, and rate of recovery.
2. Primary framework outcomes were functional independence, mobility, gait, balance, and motor control. Secondary outcomes included endurance, participation, fatigue, cognitive-motor performance, communication-related functional limitations, and psychosocial functioning. When established for the relevant population and measure, consider minimal clinically important differences; no single threshold was applied because encephalitis studies used heterogeneous instruments and rarely reported encephalitis-specific MCIDs.
3. This review did not clinically validate the framework. Its proposed dosage and monitoring elements are clinical guidance requiring patient-specific adjustment and prospective evaluation.

3. Results and Conceptual Framework

The literature synthesis identified recurring rehabilitation approaches and outcome domains, while also showing substantial methodological heterogeneity. The following findings describe reported associations and clinical observations; they do not establish treatment efficacy.

3.1 Literature Evidence Synthesis

The descriptive clinical evidence set comprised 18 reports meeting the physical therapy-specific eligibility criteria and reporting measurable motor or functional outcomes: 4 cohort studies, 4 case series/clinical series, and 10 individual case reports. Specifically, Brenner et al. [1], Michaeli et al. [18], Fillâtre et al. [19], and Sonneville et al. [20] were excluded from intervention counts because they reported outcomes without rehabilitation exposure; Wu et al. [21] and Nerkar et al. [7] concerned encephalopathy rather than encephalitis; and Anastasiadis et al. [22] and Beis & Renard [23] were conference abstracts. Kotteti et al. [24] was excluded because it was a general retrospective clinical-outcomes series without a sufficiently characterized physical therapy intervention. Urakami [25] focused primarily on neurocognitive rehabilitation; Sugahara et al. [26] on dysphagia/swallowing rehabilitation; Son et al. [27] on cognitive impairment; and Corallo et al. [28] on cognitive rehabilitation. These five reports were retained in the reference list as contextual rehabilitation literature but were not counted as physical therapy evidence or used to support physical therapy-specific efficacy claims. No randomized controlled trial specifically evaluating physical therapy after encephalitis was identified in the searched databases. The clinical evidence was therefore observational and case-based.

3.1.1 Study Selection and Evidence Base

Cohort Studies.

Four cohort studies met the inclusion criteria for physical therapy or multidisciplinary rehabilitation exposure, encompassing adult and pediatric populations [6,11,29,30]. Kim & Cheong (2021) observed significant improvements in activities of daily living (K-MBI score change from 36.8 ± 24.1 to 58.4 ± 26.5; p < 0.001) and ambulatory capacity (FAC change from 1.6 ± 1.4 to 2.8 ± 1.5; p < 0.001) among 18 encephalitis survivors during inpatient rehabilitation, whereas manual muscle test scores did not show statistically significant change [6]. Howarth et al. (2019) reported early functional gains in 27 pediatric patients with anti-NMDAR encephalitis, showing mean total WeeFIM DFQ improvements from 28.6 to 54.3 (p < 0.01) [29]. Maccarone et al. (2025) described functional rehabilitation outcomes in patients with neuroinvasive West Nile virus infection [11], while Hoffman & Paschal (2013) documented mobility and self-care gains in adult West Nile virus patients in a rehabilitation hospital setting [30]. Outcome-only cohorts lacking rehabilitation exposure [1,18,19,20] were retained for prognostic context but excluded from intervention counts. Because cohort studies lacked randomized control groups and involved concurrent medical care, reported changes cannot be attributed solely to physical therapy.

Case Series.

Four case series met the physical therapy-specific evidence criterion: Houtrow et al. [31], Tailor et al. [32], Patel et al. [33], and Bach [34]. Kotteti et al. [24] and Urakami [25] were retained only as contextual rehabilitation sources because they did not meet this criterion.

Tailor et al. (2013) reported a mean total WeeFIM Developmental Functional Quotient (DFQ) increase from 37 at admission to 64 at discharge, with a mean gain of 26.7 points (range 0-55; p < 0.001); 11 of 13 children remained below a DFQ of 85 at discharge [32]. Patel et al. (2021) reported a mean FIM increase from 45.2 (range 14-63) at admission to 82.2 (range 61-100) at discharge, with a mean total gain of 37 points (range 24-60); mean gains were 17.4 for mobility, 12.6 for ADL, and 7 for cognition [33].

Houtrow et al. [31], Tailor et al. [32], Patel et al. [33], and Bach [34] provided observational descriptions of multidisciplinary inpatient rehabilitation in autoimmune and viral encephalitis. Kotteti et al. [24] and Urakami [25] were not included in the physical therapy evidence set because the former did not sufficiently characterize a physical therapy intervention and the latter primarily addressed neurocognitive rehabilitation; both were retained only as contextual sources. The absence of control groups, small samples, concurrent multidisciplinary treatment, and non-standardized interventions limit causal interpretation.

Individual Case Reports.

Ten single-patient case reports met the physical therapy-specific evidence criterion. The report concerning encephalopathy [7] and reports primarily focused on swallowing/dysphagia [26] or cognitive/neurocognitive rehabilitation [27,28] were excluded from the physical therapy evidence set. The retained case reports described viral, autoimmune, post-infectious, and related encephalitic presentations [5,8,9,35,36,37,38,39,40,41]. Rehabilitation was most commonly initiated during the subacute phase, once acute neurological symptoms had stabilized. Frequently applied techniques included PNF, neurodevelopmental (Bobath) approaches, task-specific gait and balance training, and progressive resistive and coordination exercises [5,8,35,37]. Kunjarkar et al. (2022) and Głowacki et al. (2022) reported progress in trunk stability and foot-mediated control in severe motor deficits [9,36].

Overall, the individual case literature provides clinically informative examples of personalized physical therapy in complex presentations, while remaining hypothesis-generating because of its uncontrolled design.

To provide a transparent overview of the clinical evidence base, Table 1 summarizes the study design, sample characteristics, interventions, and key outcomes of the included reports.

Table 1 Characteristics of Included Clinical Reports (n = 18).

3.1.2 Key Reproducible Patterns Emerging from the Literature

The narrative synthesis identified recurring themes regarding timing, intervention content, multidisciplinary coordination, and outcome monitoring. These patterns informed the conceptual framework and should be interpreted in light of the low certainty and heterogeneity of the evidence:

• Early initiation and continuity of rehabilitation: Observational cohort and case-based reports describe functional improvement during rehabilitation initiated after medical stabilization; however, these studies cannot determine whether rehabilitation itself caused the observed changes [6,29,30,32,33].
• Neurofacilitation and task-oriented approaches: PNF, neurodevelopmental approaches, and task-specific training have been reported in encephalitis rehabilitation studies and case reports [32,34,35,37]. Interpret reported improvements as descriptive observations rather than evidence of independent treatment efficacy.
• Adjunctive modalities: Interferential current stimulation has been reported in a case of persistent dysphagia after anti-NMDA receptor encephalitis [26]; this swallowing-focused report was retained as contextual multidisciplinary evidence and was not included in the physical therapy evidence set. PNF, strengthening, balance and mobility exercises have been described in other encephalitis case reports [5,35,37]. Evidence for mirror therapy, virtual reality, and aerobic exercise remains insufficiently encephalitis-specific and should therefore be considered extrapolated or hypothesis-generating.
• Pediatric evidence: Case series and case reports in pediatric encephalitis describe improvements in functional independence, balance, coordination, and participation during individualized rehabilitation [5,29,31,32,40]. These observations do not establish that a specific exercise intensity or duration produces superior recovery.
• Integrated multidisciplinary interventions: In cases with complex motor and cognitive limitations, multidisciplinary interventions combining physical therapy with speech therapy, occupational therapy, and cognitive interventions were reported [40].
• Cognitive and behavioral considerations: Cognitive impairment and behavioral changes that may persist after encephalitis can limit participation and engagement in physical therapy and therefore require consideration during rehabilitation planning [1,19,30].

3.1.3 Semi-Quantitative Summary and Evidence-to-Framework Traceability

To summarize the available quantitatively reported clinical evidence in the physical therapy evidence set, Table 2 organizes the findings according to the phase of recovery, physical therapy techniques applied, functional outcomes, and supporting evidence from the literature. Of the 18 included clinical reports, only the four studies presented in Table 2 provided sufficiently explicit admission-to-discharge quantitative data to allow for semi-quantitative extraction. This synthesis highlights how intervention strategies differ across the acute, subacute, and chronic phases of recovery, as well as the corresponding clinical improvements observed in both pediatric and adult populations.

Table 2 Semi-Quantitative Summary and Evidence-to-Framework Traceability.

Based on this narrative synthesis, the recurring principles were translated into the conceptual rehabilitation framework described below.

3.2 Proposed Conceptual Rehabilitation Framework

The proposed framework is a literature-informed conceptual model that organizes physical therapy within multidisciplinary rehabilitation. It is intended to support clinical reasoning and the formulation of an individualized IRP; it was not implemented or clinically tested in the present review.

The framework requires adaptation to the patient’s etiology, clinical phenotype, rehabilitation potential, goals, tolerance, and care setting. Prospective research is required before its feasibility, safety, or effectiveness can be established.

3.2.1 Framework Structure and Traceability

The framework integrates interventions reported in the literature with established neurological rehabilitation principles and clinical reasoning. It is organized across acute, subacute, and chronic recovery phases, with phase-specific goals, tasks, candidate physical therapy interventions, outcome measures, and safety considerations. The intervention choices are recommendations for individualized planning, not claims that any modality has been validated specifically for encephalitis.

Candidate interventions include task-oriented practice, PNF, the Bobath concept, strengthening, aerobic exercise, balance and gait training, mirror therapy, virtual-reality-based exercise, and FES where clinically appropriate. Functional monitoring may include the FIM or Barthel Index, BBS, gait tests, and complementary cognitive or participation measures. Assessment timing should follow the IRP and clinical course rather than a fixed universal schedule.

Three organizing principles recur across the framework:

1. Early mobilization to prevent complications and stimulate neuromuscular activation during the acute stage;
2. Progressive task-specific activation to promote cortical reorganization, postural recovery, and independence in ADL during the subacute phase;
3. Long-term reintegration to improve endurance, community participation, and psychosocial adjustment in the chronic phase.

The accompanying tables link the recovery phase, functional target, candidate intervention, supporting study type and population, outcome measure, and clinical rationale. No formal consensus panel or prospective validation formed part of this narrative review.

Table 3 presents the author-developed conceptual framework, including goals, candidate interventions, dosage considerations, outcome domains, and safety notes. Dosage values are illustrative and must be individualized within the individual recovery plan.

Table 3 Conceptual Physical Therapy Framework for Motor and Functional Recovery after Encephalitis.

Because encephalitis includes infectious, autoimmune, and postinfectious etiologies with diverse motor, cognitive, behavioral, seizure-related, fatigue, autonomic, and cardiorespiratory profiles, Table 4 provides phenotype-responsive considerations for common clinical problems. These suggestions complement, but do not replace, medical assessment and individualized multidisciplinary planning.

Table 4 Adaptable Physical Therapy Considerations for Common Problems following Encephalitis.

3.2.2 Individualization, Multidisciplinary Integration, and Outcome Monitoring

The framework should be operationalized through an IRP developed with the patient or proxy and coordinated by the multidisciplinary team under the leadership and medical responsibility of a Physical and Rehabilitation Medicine physician/physiatrist, consistent with the UEMS-PRM European framework [12]. The team may include physical therapists, occupational therapists, speech and language therapists, psychologists or neuropsychologists, neurologists, nurses, and other professionals according to patient needs.

Physical therapy addresses movement-related goals, whereas occupational, communication, swallowing, cognitive, behavioral, and psychosocial needs require coordinated discipline-specific assessment and intervention. Goals and progression should be reviewed jointly as neurological status, fatigue, seizure risk, participation, and functional priorities evolve.

Table 5 provides an illustrative subacute-phase session structure. It is an example for clinical reasoning, not a fixed prescription or evidence of feasibility.

Table 5 Illustrative Therapeutic Session Structure for the Subacute Phase.

Outcome monitoring should prioritize functional independence, mobility, gait, balance, and motor control. Secondary domains may include endurance, fatigue, participation, cognitive-motor performance, communication-related limitations, and psychosocial functioning. Measure selection and assessment frequency should reflect patient age, phenotype, baseline ability, goals, and established MCIDs where applicable. The current literature does not support a universal core threshold; development of an encephalitis rehabilitation core outcome set is a priority for future research.

3.2.3 Implications for Future Research

Prospective studies should evaluate the framework’s feasibility, safety, acceptability, and effectiveness; stratify results by infectious, autoimmune, and postinfectious etiology and by pediatric or adult population; and report intervention content and dosage transparently. Future work should also define a core set of outcomes spanning motor, functional, cognitive, behavioral, participation, fatigue, and quality-of-life domains.

4. Discussion

This discussion interprets the narrative literature synthesis, explains the clinical rationale for the conceptual framework, and identifies limitations that constrain causal inference and generalizability.

4.1 Overview and Key Findings

This narrative review organizes heterogeneous rehabilitation evidence into a phase-specific conceptual framework for motor and functional recovery after encephalitis. Its contribution is translational: it links reported interventions with functional targets, patient characteristics, outcome monitoring, and multidisciplinary IRP planning. It does not provide clinical validation or evidence of protocol efficacy.

Previous research on post-encephalitic rehabilitation has largely relied on observational cohorts, small case series, and case reports with heterogeneous populations and interventions [5,42]. This limits comparison, generalizability, and causal attribution. The framework offers a structured way to organize that evidence across recovery phases while preserving the need for patient-specific adaptation.

Standardized measures such as the FIM, Barthel Index, BBS, MAS, gait tests, and age-appropriate cognitive or participation measures may support longitudinal monitoring, but instrument choice and interpretation should be individualized. The authors present evidence-derived observations and clinical recommendations separately.

4.2 Critical Appraisal and Comparison with Existing Literature

The conceptual framework builds on a fragmented evidence base. Most included clinical reports describe change during multidisciplinary rehabilitation rather than the isolated effect of physical therapy [4,6]. The framework’s novelty lies in transparent clinical organization, not in claiming new therapeutic efficacy.

Compared with reports focused on individual techniques, the framework places candidate modalities within a continuum of goals, safety considerations, and outcome monitoring. The proposed dosage values are clinical starting points requiring individualized adjustment and empirical study; they should not be interpreted as validated encephalitis-specific prescriptions.

Early mobilization after medical stabilization and repetitive, goal-directed practice are biologically plausible principles used in broader neurorehabilitation and have also been described in encephalitis rehabilitation reports [3,4,5,6,10,11]. Extrapolation from stroke or traumatic brain injury should nevertheless be cautious because encephalitis-specific inflammatory, cognitive, behavioral, seizure-related, autonomic, and fatigue profiles may alter tolerance and recovery.

No prospective implementation, patient-level testing, or formal safety evaluation was performed in this study. Accordingly, the framework’s feasibility, acceptability, safety, and effectiveness remain to be established in appropriately designed clinical research.

4.3 Limitations and Future Directions

The principal limitation is the narrative and conceptual design. The search was structured but was not conducted as a systematic review, and no formal risk-of-bias or certainty-of-evidence assessment was undertaken. The evidence base was dominated by observational studies, case series, and case reports, with substantial clinical and methodological heterogeneity and no randomized trials specifically evaluating physical therapy after encephalitis. These limitations preclude causal conclusions.

The framework may overgeneralize across infectious, autoimmune, and postinfectious encephalitis. Etiology, age, lesion pattern, cognitive and behavioral involvement, seizure history, fatigue, autonomic and cardiorespiratory status, premorbid function, complications, resources, and rate of recovery may all require subtype- and setting-specific adaptation.

Outcome reporting was inconsistent and rarely incorporated established MCIDs, which prevented a defensible semi-quantitative synthesis across studies. Concurrent medical and multidisciplinary interventions also make it difficult to isolate the contribution of physical therapy. Future research should use transparent intervention reporting, predefined primary and secondary outcomes, and appropriate comparison groups.

Prospective multicenter studies should stratify infectious, autoimmune, and postinfectious subtypes; distinguish pediatric and adult populations; assess motor, cognitive, behavioral, participation, fatigue, and quality-of-life domains; and develop a core outcome set for encephalitis rehabilitation. Long-term follow-up is needed to determine sustainability and community reintegration [6].

5. Conclusions

Encephalitis can cause complex motor, cognitive, behavioral, and participation restrictions requiring individualized multidisciplinary rehabilitation. The available observational and case-based literature describes improvements in mobility, balance, motor control, and functional independence during multidisciplinary rehabilitation after medical stabilization. However, heterogeneous populations, concurrent treatments, small samples, inconsistent outcome reporting, and the absence of encephalitis-specific randomized trials prevent causal or quantitative conclusions.

The proposed conceptual framework translates recurring literature-based principles into phase-specific, phenotype-responsive considerations for the IRP. It is a flexible clinical reasoning aid rather than a standardized or validated treatment protocol, and it requires coordination under rehabilitation medical supervision and adaptation to etiology, age, impairments, tolerance, goals, and care setting.

Future prospective studies should evaluate feasibility, safety, acceptability, and effectiveness; define intervention dosage and progression criteria; and use a core set of motor, functional, cognitive, behavioral, participation, fatigue, and quality-of-life outcomes.

Overall, the framework offers a transparent, clinically oriented synthesis of current knowledge and a basis for future validation. It should not be interpreted as evidence of established treatment efficacy.

Abbreviations

Acknowledgments

The authors acknowledge the financial support provided by the University of Ruse “Angel Kanchev,” Bulgaria, for covering the publication costs of this article.

Author Contributions

Irina Karaganova: Conceptualization, writing - original draft, formal analysis, writing - review and editing. Stefka Mindova: Methodology, writing - review and editing. All authors have read and approved the published version of the manuscript.

Funding

The publication of this article was financially supported by the University of Ruse “Angel Kanchev,” Bulgaria.

Competing Interests

The authors have declared that no competing interests exist.

AI-Assisted Technologies Statement

Artificial intelligence (AI) tools were used solely for basic grammar correction and language refinement in the preparation of this manuscript. Specifically, OpenAI’s ChatGPT was employed to improve the readability and linguistic clarity of the English text. All scientific content, data interpretation, and conclusions were developed independently by the authors. The authors have thoroughly reviewed and edited the AI-assisted text to ensure its accuracy and accept full responsibility for the content of the manuscript.