Early Physiotherapy With Bimanual Intensive Training in a Child With Miller Fisher Syndrome: A Rare Case Report

Miller Fisher syndrome (MFS) is a rare variant of Guillain-Barré syndrome (GBS), which typically affects adults, but paediatric cases are rare. There is insufficient evidence on the motor recovery strategies, task-specific rehabilitation, and neuroplasticity-based intervention in paediatric neuro-immune conditions like MFS. This case report describes a 4-year-old male child who developed MFS following a gastrointestinal infection. The child presented with progressive bilateral upper limb weakness. Clinical features included bilateral ophthalmoplegia, facial nerve involvement, ataxic gait, hypotonia, and hyporeflexia. Nerve conduction study revealed asymmetric motor axonal polyneuropathy. The child was administered intravenous immunoglobulin. An 8-week physiotherapy protocol focused on facial stimulation, limb strengthening, respiratory training, and balance exercises. A physiotherapy regimen resulted in significant improvements in muscle strength, reflexes, facial motor function, gait, cranial nerve function, and overall mobility. The manual muscle strength improved from 2/5 to 4/5, and facial nerve function improved from grade 5 to grade 2 on the House-Brackmann scale. The incorporation of both conventional and task-specific therapies, including BIT, postural control, and strengthening, showed improvement in muscle grades, reflexes, gain, and fine motor function. To the best of our knowledge, this case report is among the first to document the successful use of a bimanual intensive training (BIT) protocol in a child with MFS. For clinicians, this study highlights the importance of early rehabilitation, particularly physiotherapy, in managing rare neurological syndromes like MFS.