## 4 Discussion
Currently, studies on respiratory outcomes in WNV patients are lacking [4]. Early-phase rehabilitation should focus on enhancing ventilatory function, preventing atelectasis, and strengthening the diaphragm and inspiratory muscles, particularly in those with respiratory muscle impairments due to motoneuron or brainstem issues [26; 27]. Early assessment for dysarthria and dysphagia is also important, as they can predict later respiratory failure [27; 28]. The lack of significant improvement in Barthel Index scores during hospitalization reflects the severity and chronicity of impairments in our cohort. Despite early rehabilitation, some patients with severe or long-term impairments may require more time for functional recovery. The low Barthel Scale values at admission and discharge indicated significant deficits in motor function and daily activities due to WNND, which extended beyond hospitalization. This justified the inability of ten patients to return home immediately after discharge. Instead, six were transferred to community hospitals, and four were referred to rehabilitation or long-term care facilities for vegetative states. In a previous study focusing on five subjects with WNND admitted to an acute inpatient brain injury rehabilitation facility in the United States, the efficacy of targeted rehabilitation was evaluated using the Functional Independence Measure (FIM) as a metric. The results indicated significant improvements in functional independence from admission to discharge across several subcategories: cognitive function, mobility, and ADL [29]. These findings underscore the potential benefits of customized rehabilitation programs in enhancing functional outcomes and suggest that some patients may achieve sufficient recovery to be discharged to their homes. However, enduring deficits may persist, particularly in patients with encephalitis complicated by AFP. Indeed, only a small percentage of WNND patients seem to regain their previous functional levels after 6-8 months of rehabilitation [4; 12; 29; 30]. Consequently, continuing rehabilitation care in inpatient or outpatient settings post-hospitalization is advisable for these patients [19]. In another study, the functional impairments and outcomes of 48 adults with WNV admitted to a rehabilitation facility between 2002 and 2009 were assessed. Patients were transferred to the rehabilitation hospital from acute care settings after lengths of stay ranging from 1 to 62 days, with their time in rehabilitation varying from 2 to 304 days. The change in FIM scores during inpatient rehabilitation was statistically significant, highlighting the significant improvements achieved through rehabilitation [31]. In the post-acute phase, a multidisciplinary approach to rehabilitation should be adopted, integrating physical therapy, occupational therapy, speech therapy, and psychological support [22; 32]. Indeed, while limiting complications and preventing muscle and movement function loss are essential during hospitalization, post-acute care should focus on promoting autonomy recovery [4; 30; 33]. The rehabilitation plan should be individualized, considering not only the acute condition but also comorbidities, previous levels of autonomy, and the prognosis of each subject. The main strength of this study is its comprehensive analysis of the rehabilitation needs, rehabilitation programs, and discharge settings for a real-life cohort of patients with WNND. Unlike previous research, which often focuses on individual cases or small sample sizes, this study assesses a larger and more diverse group of patients [3; 28; 31; 32; 34]. While our findings underscore the importance of early and individualized rehabilitation protocols, there are notable limitations that should be addressed in future research. The lack of long-term follow-up data restricts our ability to assess sustained recovery and functional outcomes beyond the acute phase.