Physiatry and care of patients with neurofibromatosis.

To the Editor. —In their overview of neurofibromatosis, Dr Gutmann and colleagues 1 present "a comprehensive approach to the diagnosis and treatment of individuals with neurofibromatosis 1 [NF1] and neurofibromatosis 2." Unfortunately, the physiatric perspective was omitted in their plan of care. We write from the perspective of a neurologist with NF1 and her physiatrist. Dr Levy's Perspective. —I have followed Dr Krietemeyer since she was a neurology resident facing increasing difficulties with ambulation and fatigue. Neurofibromas have encased virtually every spinal nerve root. Over 3 years I have prescribed ankle-foot-orthoses, canes, rollator walkers, and physical therapy to enable ambulation, and a scooter and later a powered wheelchair to conserve energy. The Ohio Bureau of Vocational Rehabilitation was enlisted, resulting in a van with a wheelchair lift and hand controls. Work site modifications (powered exam tables, powered doors) are now being pursued. Adjustment issues have also been addressed. As a