Impact of Integrated Physiotherapy and Speech-language Rehabilitation on Functional Recovery in Nonfluent Aphasia with Brachiofacial Paresis Following Middle Cerebral Artery Infarction

Abstract

Nonfluent (Broca-type) aphasia with predominant brachiofacial motor deficits is an uncommon presentation of dominant-hemisphere middle cerebral artery (MCA) infarction. Evidence describing outcomes of integrated physiotherapy and speech-language rehabilitation in this phenotype remains limited. A 43-year-old right-hand–dominant female presented with sudden-onset right facial deviation, right upper-limb weakness, and nonfluent speech. Symptom onset-to-hospital arrival time was approximately 2 h. Neuroimaging confirmed a left MCA territory infarct, and stroke severity was moderate (National Institutes of Health Stroke Scale score = 8). Baseline Functional Independence Measure (FIM) score was 35, indicating severe functional dependence. A 6-week, neuroplasticity-driven rehabilitation program was initiated on day 3 poststroke. Physiotherapy was delivered for 45 min/day, 6 days/week, progressing from early mobilization to task-specific upper-limb training and functional integration. Concurrent speech-language therapy (30 min/day) focused on oral-motor strengthening, articulation drills, picture naming, sentence construction, and conversational practice. Exercise intensity was progressively increased, with continuous monitoring of vital parameters to ensure safety. At 6 weeks, the FIM score improved from 35 to 98. Upper-limb voluntary control, facial symmetry, and independence in self-care tasks improved markedly. Naming accuracy increased to approximately 85%, spontaneous sentence length normalized, and functional conversation was restored. Teleconsultation follow-up at 4 weeks postdischarge confirmed maintenance of gains. Early, intensive, and integrated physiotherapy and speech-language rehabilitation can facilitate substantial motor and language recovery in patients with nonfluent aphasia and brachiofacial paresis following MCA infarction.