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Background: Neuromyelitis opticans (NMO) is an immune-mediated inflammatory disorder of the central nervous system, characterized by neuron demyelination that primarily targets the spinal cord and optic nerves. Diagnostic features of NMO include presence of a serum NMO-immunoglobulin G (IgG) antibody that binds to aquaporin-4 (AQP-4) and acute flare-ups of bilateral optic neuritis and myelitis. Purpose: Due to limited research about NMO, the purpose of this case report is to describe the clinical decision-making process used to create an inpatient rehabilitation treatment plan for a patient with newly diagnosed neuromyelitis optica. Case Description: A 45-year-old African American female presented to the emergency department with progressive weakness of her bilateral lower extremities, which had advanced to a point where she was no longer able to walk or move her legs during her initial hospital stay. Following her diagnosis of NMO, she was transferred to an inpatient rehabilitation department, where she spent the next four weeks working with physical and occupational therapy. Discussion: NMO remains a very rare, poorly understood diagnosis with very little evidence to support effective physical therapy interventions. The available research was accessed and utilized in an effective manner, allowing the patient to achieve significant functional gains prior to returning home.