Rehabilitation Challenges After Sequential Neurological Detorioration in a Glioblastoma Multiforme : A Case Report

Case Diagnosis: Glioblastoma multiforme (GBM) in a 55-year-old female with progressive neurological decline after initial rehabilitation.

Case Description or Program Description: A 55-year-old female patient, diagnosed with GBM in the left parieto-temporal area, underwent tumor removal and concurrent chemoradiotherapy (CCRT). After three weeks of rehabilitation, she regained independent walking (>100m), with Mini-Mental State Examination (MMSE) improving from 21 to 25 and Modified Barthel Index (MBI) from 72 to 81. However, over a year of follow-up with nine CCRT sessions, her right-sided weakness, cognitive impairment, and speech disorder worsened.

Setting: Inpatient rehabilitation hospital

Assessment/Results: Upon re-admission, she required maximal assist for sit-to-stand, showed poor static standing balance, and had MMSE 7, MBI 15, and severe global aphasia. Frequent drowsiness and depressive, unstable mood hindered rehabilitation. A different rehabilitation goal was set, requiring a multidisciplinary approach. Therapy focused on sitting balance training, sit-to-stand, and bed-to-wheelchair transfers. She was encouraged to communicate by imitating words and using short phrases. EEG and MRI were taken to rule out nonconvulsive status epilepticus. She was discharged with MBI 19, capable of hemiwalker standing with maximal assist.

Discussion (relevance): This case highlights key rehabilitation challenges in a GBM patient undergoing a second rehabilitation phase after progressive neurological decline. Cognitive deterioration reduced engagement, while motor weakness and balance impairments necessitated targeted training. Frequent drowsiness and mood instability further hindered therapy, requiring psychosocial support. Unlike studies comparing primary and recurrent GBM cases, this report emphasizes rehabilitation challenges within a single patient over time, underscoring the need for individualized rehabilitation plans and a multidisciplinary approach to optimize functional recovery.

Conclusions: Patients with GBM may experience significant neurological decline over time, necessitating rehospitalization. This case underscores the importance of adapting rehabilitation strategies based on disease progression, emphasizing individualized care and multidisciplinary approach to optimize functional outcomes.