This case report aims to describe the progress of physiotherapy of a patient diagnosed with MBD who achieved walking independence through conventional physiotherapy combined with task difficulty-adjusted one-leg standing exercises. The report also seeks to contribute to future treatment approaches for MBD.
A man in his 40s was found collapsed in his home and subsequently diagnosed with MBD after MRI showed abnormal signals in the corpus callosum. A month after the initial diagnosis, the patient was transferred to a comprehensive rehabilitation unit for intensive physiotherapy. Upon admission, his physical function was assessed using the Stroke Impairment Assessment Set (SIAS), scoring 5-5 in both upper limbs and 4-4-4 in the right and 5-5-4 in left lower limbs. Cognitive impairments, including deficits in working memory and processing speed, were also noted. Initially, the patient exhibited walking difficulties, scoring 4 on the Functional Independence Measure (FIM) for walking within parallel bars, primarily due to stumbling from toe catching. Ankle-foot orthoses (AFO) were fitted to both feet to assist in gait training. After one month, his gait improved to a cane-assisted FIM of 4-5, though stumbling persisted. To address this, task difficulty-adjusted one-leg standing exercises were added to his routine to enhance lower limb support and improve foot clearance during the swing phase of walking, and this was instructed to continue after discharge.
Upon discharge, five months after his onset, the patient’s SIAS scores for lower limb function improved to right 5-4-4 and left 5-5-5, with continued improvements in higher brain function, although working memory and processing speed deficits remained. His walking ability improved to an FIM of 4-5 without a cane, although he continued to wear an AFO on the right foot to manage persistent stumbling. Upon discharge, the patient’s mobility plan included independent walking at home and supervised use of a cane for outdoor walking. Two months after discharge, the patient could walk independently at home and took hour-long walks outdoors using a cane.
This case illustrates the potential for significant functional recovery in young patients with MBD through a combination of conventional physiotherapy and targeted exercises including task difficulty-adjusted one-leg standing. The patient achieved independence in indoor walking and improved outdoor mobility despite persistent cognitive impairment. Although the patient required assistance at the time of discharge, he continued to make progress post-discharge, demonstrating potential for continued functional recovery after rehabilitation.
Given the rarity of MBD, physiotherapy guidelines are not well-established. This case report highlights the potential benefits of task-specific exercises in improving gait and walking independence in patients with MBD. Future case studies are needed to refine physiotherapy interventions and improve the predictability of outcomes in MBD rehabilitation.
independent walking
task difficulty
