Physiotherapy rehabilitation following pontine stroke

Malathi*. R, Santhosh kumar, Jothi

Rehabilitation Team, Kauvery Hospital, HAMSA, Trichy, Tamil Nadu

Abstract

Background

Pontine strokes account for approximately 10% of all ischemic events. They cause severe balance deficits, hemiparesis, and a loss of functional independence. Early, tailored physiotherapy is critical to stimulate neuroplasticity and maximize motor recovery.

Case Description

A 38-year-old male diagnosed with a pontine stroke presented with severe balance impairment and high functional dependence. He was admitted to the Department of Physiotherapy at the Kauvery Rehabilitation Unit for inpatient care.

Interventions

The patient completed a structured, individualized physical therapy program. Interventions focused on bed mobility, trunk stabilization, and progressive strengthening. Treatment also featured static and dynamic balance training, facial proprioceptive neuromuscular facilitation (PNF), and repetitive, task-specific gait re-education.

Outcomes

Repeated objective outcome measures demonstrated outstanding clinical recovery. The Berg Balance Scale (BBS) score improved from 10/56 at admission to 50/56 at discharge, marking a 50-point advancement in balance control. The Functional Independence Measure (FIM) score advanced from 48/126 to 108/126, transitioning the patient from severe dependence to a state of modified independence and supervision.

Conclusion

Early, intensive, and individualized physiotherapy rehabilitation can significantly reverse profound balance deficits, restore muscle strength, and return functional autonomy to patients recovering from a pontine stroke.

Keywords: Pontine stroke; Physiotherapy rehabilitation; Berg Balance Scale (BBS); Functional Independence Measure (FIM); Neuroplasticity; Balance training; Gait re-education; Case report.

Introduction

Pontine stroke is a brainstem stroke affecting the pons and commonly results in hemiparesis, impaired balance, gait dysfunction and reduced functional independence. Early individualized physiotherapy rehabilitation is essential to improve neuroplasticity, balance, strength and activities of daily living. Accounting for roughly 10% of all strokes, its symptoms include sudden severe dizziness, loss of balance, slurred speech, swallowing difficulties, and weakness or paralysis on one or both sides of the body. In severe cases, it can cause locked-in syndrome, leaving a patient fully conscious but unable to move or communicate except through eye movements. Key risk factors include high blood pressure, high cholesterol, and smoking, making immediate emergency medical intervention crucial for survival and limiting long-term damage.

Study design

Single-patient case study

Study setting

Department of Physiotherapy, Kauvery Rehabilitation Unit.

Outcome measures

  • Balance – Berg Balance Scale (BBS)
  • Muscle power – MMT
  • Gait analysis scale – Gait Dynamic Index
  • Activities of Daily Living – Functional Independent Scale

Procedure Techniques

A 38-year-old male, diagnosed with pontine stroke, underwent inpatient physiotherapy at Kauvery Rehabilitation Unit. Baseline assessment was performed using BBS and MRC. A structured rehabilitation programme was provided and progress was monitored with repeated outcome measures.

  • Bed mobility and transfer training
  • Trunk stabilization exercises
  • Static and dynamic balance training
  • Progressive strengthening exercises
  • Gait re-education and functional walking
  • Facial PNF and Exercises

Data analysis

Berg Balance Scale (BBS) Analysis

  • Admission (10/56): Indicates severe balance impairment
  • Discharge (50/56): Represents a 50-point improvement

Functional Independence Measure (FIM)

  • Admission (48/126): Reflects severe dependence
  • Discharge (108/126): Represents a Modified Independence/Supervision

Limitations

Single case report

Short follow-up

Recommendations

  • Larger sample studies
  • Longer follow-up
  • Include additional outcome measures

Discussion

The structured rehabilitation program improved balance, muscle strength and functional mobility. Task-specific training and repetitive practice contributed to motor recovery.

Conclusion

Early individualized physiotherapy rehabilitation can significantly improve balance, muscle strength, gait and independence following pontine stroke.

References

  • Wadhokar, O. C., et al. (2024). Physiotherapy Approach to a Bilateral Pontine Infarct with Acute Ischemic Stroke: A Case Report. Cureus, 16(2).
  • Cureus Case Report. (2024). Harnessing Neuroplasticity: A Case Report on Physiotherapy Rehabilitation for Millard-Gubler Syndrome. Cureus, 16(3).
  • Case Study Report. (2025). Sudden Knee Buckling During Gait Caused by Infarction of the Paramedian Pontine Artery: A Case Report. Cureus, 17(9).
  • Student Research Collection. (2020). Inpatient Rehabilitation For A 75-Year-Old Female Following a Pontine Stroke. University of New England DUNE Digital Repository.
  • : Berg, K., Wood-Dauphinee, S., Williams, J. I., & Maki, B. (1989). Measuring balance in the elderly: validation of an instrument. Canadian Journal of Public Health, 80(4), 304–311.
  • Kendall, F. P., McCreary, E. K., Provance, P. G., Rodgers, M. M., & Romani, W. A. (2005). Muscles: Testing and Function with Posture and Pain.
  • Schwartz, M. H., & Rozumalski, A. (2008). The Gait Deviation Index: a new comprehensive index of gait pathology. Gait & Posture, 28(3), 351–357

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