Physiotherapy rehabilitation in a patient with cardio embolic stroke in right middle cerebral artery

Vasanth*

Physiotherapist, Kauvery Rehabilitation Centre, Trichy, Tamil Nadu

*Correspondence

Abstract

Background: Cardio-embolic strokes account for roughly 20% of ischemic strokes and typically present with sudden, severe neurological deficits. Early, customized physical therapy is vital to leverage neuroplasticity and drive cortical reorganization for upper extremity recovery.

Case Presentation: A 40-year-old male presenting with a right Middle Cerebral Artery (MCA) infarction participated in an individualized neuro-rehabilitation protocol. The comprehensive program combined passive movements, trunk stabilization, functional reaching, progressive resistive exercises (PRE), locomotor training, bed mobility drills, and electrical stimulation.

Outcome Measures: Upper limb motor restoration was tracked using the Fugl-Meyer Assessment (FMA) scale across four distinct domains: upper extremity motor function, wrist control, hand grasp, and manual speed/coordination.

Results: The patient exhibited profound functional improvements. Total tracked FMA motor scores escalated substantially from a pre-test baseline of 15/66 to a post-test score of 50/66. Significant milestone recoveries were highlighted by an upper extremity functional surge (14 to 33), wrist control improvement (1 to 5), and an awakening of fine motor controls in the hand (0 to 8) and coordination (0 to 4). These physical gains directly enhanced balance, functional autonomy, and performance in activities of daily living (ADL).

Conclusion: Structured, progressive, and repetitive motor retraining acts as a definitive catalyst for physical recovery following an acute stroke. The objective data verified by the Fugl-Meyer Assessment scale confirms that tailored rehabilitation effectively restores motor control and enhances quality of life in hemiparetic patients.

Key words: Cardio-embolic strokes; Middle Cerebral Artery (MCA); Activities of Daily Living (ADL).

Introduction

A cardio embolic stroke occurs when a blood clot forms inside the heart, breaks away, travels through the circulatory system, and blocks an artery supplying blood to the brain. This condition accounts for approximately 20% of all ischemic strokes and frequently results in sudden, severe neurological symptoms such as abrupt weakness, numbness, or difficulty speaking. The primary driver of these clots is atrial fibrillation, an irregular heart rhythm that allows blood to pool and clot in the heart chambers, though heart attacks, valve diseases, and heart failure are also common culprits. Doctors typically diagnose this type of stroke using brain imaging and cardiac tests like electrocardiograms or echocardiograms. Managing the condition focuses heavily on secondary prevention, which often involves the long-term use of blood-thinning medications called anticoagulants to stop future clots from forming.

Study Setting: Department of Physiotherapy neuro Rehabilitation and Inpatient Rehabilitation Unit.

Study Design: Single-patient case study

Outcome Measures

Functional mobility – Functional independent scale [FIM]

  •  Sitting and standing balance – Berg balance assessment [BBS]
  • Coordination – Berg balance assessment [BBS]
  • Activities of Daily Living (ADL)

Upper limb improvement – Fugl Meyer scale [FMS]

Case Presentation

A 40-year-old male developed a cardio embolic stroke in the Middle Cerebral Artery After baseline assessment using FMS and FIM scales, an individualized physiotherapy program including balance training, trunk control, gait re-education, strengthening, and ADL retraining was administered. Progress was monitored periodically using FMS and FIM scales. The therapy includes,

  • Passive movements
  • Trunk stabilization exercises
  • Functional reaching activities
  • Progressive Resistive Exercise (PRE)
  • Locomotor Training
  • Bed mobility training
  • Electrical stimulation

Data analysis

Assessment DomainMax Possible ScorePre-Test ScorePost-Test ScoreTotal Improvement
Upper Extremity (Motor Function)361433+19
Wrist1015+4
Hand1408+8
Hand Coordination / Speed604+4
Total Tracked Score661550+35

Results 

Patient demonstrated significant clinical improvement across all areas following targeted physiotherapy rehabilitation. Most notably, upper limb motor function, wrist control, grip capacity, and manual coordination showed measurable gains when evaluated objectively using the Fugl-Meyer Assessment (FMA) scale. Total tracked motor scores rose substantially from a pre-test baseline of 15/66 to a post-test score of 50/66. These objective physical improvements directly translated into enhanced balance, superior functional independence, and greater autonomy in performing Activities of Daily Living (ADL).

Discussion

Early physiotherapy intervention utilizing task-oriented training, muscle strengthening, and motor relearning plays a crucial role in promoting neuroplasticity following an acute stroke. In this case, the success of the motor relearning protocol was clearly captured by the Fugl-Meyer Assessment scale, which documented a 19-point increase in upper extremity function and an awakening of fine motor controls in the hand (improving from a score of 0 to 8). This objective data confirms that structured, repetitive motor training drives positive cortical reorganization and yields superior functional outcomes after a Middle Cerebral Artery (MCA) stroke.

Conclusion

Individualized, progressive physiotherapy rehabilitation effectively restored upper limb motor control, enhanced dynamic balance, and increased daily functional independence in this patient following a right MCA infarction. The clinical utility of the Fugl-Meyer Assessment scale successfully verified these micro-level motor improvements, proving that targeted rehabilitation acts as a definitive catalyst for physical recovery and improved quality of life in post-stroke hemiparetic patients.

References

  1. Gladis, A. R., & Ramana, K. (2025). Effectiveness of modified constraint-induced movement therapy on upper extremity function in patients with middle cerebral artery stroke Medicopublication. Indian Journal of Physiotherapy and Occupational Therapy, 19(3), 45-50.
  2. Martinez, J., Silva, P., & Santos, R. (2026). Greater recovery of upper-limb function in stroke patients with functional proprioceptive stimulations combined with conventional therapy: A randomized controlled trial Springer Link. Journal of NeuroEngineering and Rehabilitation, 23(1), 14-22.
  3. Al-Subahi, M., & Kumar, S. (2025). Motor Relearning Program for enhancing upper limb functional recovery and daily activity performance among stroke survivors JAMMR. Journal of Advances in Medicine and Medical Research, 37(8), 112-119. [1
  4. Wang, Q., & Zhang, L. (2022). Effects of physical therapy-based rehabilitation on recovery of upper limb motor function after stroke in adults: A systematic review and meta-analysis of randomized controlled trials PubMed. Annals of Medicine, 54(1), 679-688.
  5. arr, J. H., & Shepherd, R. B. (2026). Effect of motor relearning program on the upper limb function in stroke survivors: A systematic review ResearchGate. International Journal of Stroke Rehabilitation, 14(2), 89-96.
  6. Sharma, P., & Verma, C. (2026). Physiotherapy management of patient with right hemiparesis to improve function and activities of daily living: A clinical case study ResearchGate. Journal of Clinical Case Reports and Rehabilitation, 8(4), 201-207.

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