Early Intensive Physiotherapy Drives Functional Recovery in Pediatric Acute Disseminated Encephalomyelitis: A Quantified Case Report

Structured physiotherapy protocols for pediatric acute disseminated encephalomyelitis (ADEM) remain inadequately described in the literature, despite persistent neurological deficits occurring in approximately 20% of cases. We report a 13-year-old MOG-antibody-positive male with ADEM who presented with severe bilateral weakness (Manual Muscle Testing 1-3/5), ataxic gait, bladder dysfunction, and complete functional dependence (Functional Independence Measure [FIM]: 55/126). Following medical stabilisation, an 8-phase, 16-week intensive physiotherapy protocol was implemented alongside immunomodulatory therapy, incorporating progressive strengthening, proprioceptive training, balance activities, and task-specific gait rehabilitation based on neuroplasticity and motor learning principles. Outcomes were quantified using 6 validated measures. Walking speed increased by 316% (0.18-0.75 m/s); FIM improved by 60 points (55-115/126); Berg Balance Scale increased by 30 points (18-48/56); Functional Ambulation Category progressed from level 1 (non-functional) to level 5 (independent community ambulation); Pediatric Quality of Life Inventory increased by 40 points (45-85/100); and bladder dysfunction completely resolved. As spontaneous recovery occurs in up to 80% of pediatric ADEM cases and a control condition was absent, functional gains cannot be attributed to the physiotherapy programme alone; however, the breadth and pace of documented recovery across 6 validated domains within 16 weeks provides the first detailed, replicable phased physiotherapy framework for pediatric ADEM with quantified benchmarks that may guide clinical practice and inform future controlled trials.