Tailored Physiotherapy Management of Motor Neuron Disease with Predominant Lower Motor Neuron Involvement in a Young Adult: A Case Report

Tailored Physiotherapy Management of Motor Neuron Disease with Predominant Lower Motor Neuron Involvement in a Young Adult: A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Tailored Physiotherapy Management of Motor Neuron Disease with Predominant Lower Motor Neuron Involvement in a Young Adult: A Case Report Purvi Lokesh Jadhwani, Irshad Qureshi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8945808/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Motor neuron disease (MND) is a progressive neurodegenerative disorder involving degeneration of upper and/or lower motor neurons, resulting in muscle weakness and functional decline. Progressive muscular atrophy (PMA) represents a lower motor neuron–predominant phenotype within the MND spectrum and commonly presents with distal limb weakness and progressive disability. Objective: To describe the clinical, electrophysiological, and functional outcomes of a young adult with lower motor neuron–predominant motor neuron disease managed with tailored physiotherapy rehabilitation. Methods and Materials: A middle aged male with progressive bilateral lower limb weakness for one year and tingling sensations for six months was evaluated clinically and electrophysiologically. He had a prior history of lumbar laminectomy following a road traffic accident and was a known case of MND. Assessment included neurological examination and electromyography, which demonstrated a neurogenic pattern consistent with predominant lower motor neuron involvement. A structured, goal-oriented physiotherapy program focusing on strength maintenance, balance training, gait re-education, and functional mobility was implemented. Results: Post-rehabilitation assessment revealed improvement in balance, ambulation, functional independence, and activities of daily living, with stabilization of muscle strength and improved gait safety. Conclusion: Early diagnosis and individualized physiotherapy intervention play a crucial role in preserving functional abilities and improving quality of life in patients with lower motor neuron–predominant motor neuron disease. Neurosurgery Motor neuron disease Progressive muscular atrophy Lower motor neuron Electromyography Amyotrophic lateral sclerosis Figures Figure 1 Key Message Early diagnosis and tailored physiotherapy are essential to preserve function and improve quality of life in motor neuron disease. INTRODUCTION Motor neuron diseases (MNDs) constitute a heterogeneous group of progressive neurodegenerative disorders characterized by selective involvement of upper motor neurons (UMNs), lower motor neurons (LMNs), or both, resulting in muscle weakness, atrophy, spasticity, and subsequent functional impairment. Amyotrophic lateral sclerosis is the most common form, accounting for approximately 80–85% of cases, followed by primary lateral sclerosis, progressive muscular atrophy, and progressive bulbar palsy ( 1 ). The global prevalence of MND is estimated at 1–2 per 100,000 population annually, with a higher incidence in males and a typical onset between the fifth and seventh decades of life .Pathologically, MND involves degeneration of motor neurons in the motor cortex, brainstem nuclei, and anterior horn cells of the spinal cord, leading to combined UMN and LMN manifestations ( 2 ). Clinically, patients present with progressive limb weakness, muscle wasting, fasciculations, spasticity, impaired fine motor control, and, in advanced stages, bulbar and respiratory involvement, which significantly affect prognosis and quality of life ( 3 ). Although the exact etiology remains unclear, proposed mechanisms include glutamate excitotoxicity, oxidative stress, mitochondrial dysfunction, abnormal protein aggregation, and genetic mutations such as SOD1 and C9orf72 ( 4 ) Electrodiagnostic studies, particularly electromyography, are crucial for detecting LMN involvement through neurogenic patterns of chronic denervation and reinnervation, while nerve conduction studies help exclude peripheral neuropathies ( 5 )( 6 ). Early diagnosis facilitates timely multidisciplinary management, including physiotherapy, which plays a vital role in preserving function, reducing complications, and improving quality of life using standardized outcome measures.( 7 ).( 8 )This case report aims to present a detailed clinical, electrophysiological, and physiotherapeutic profile of a patient diagnosed with motor neuron disease demonstrating a neurogenic pattern on EMG, highlighting the role of electrodiagnostic evaluation in diagnosis and the impact of structured physiotherapy intervention on functional outcomes.( 9 ) The report also emphasizes the relevance of appropriate outcome measures in tracking disease progression and rehabilitation efficacy.( 7 ) CASE REPORT A middle aged male presented with progressive bilateral lower limb weakness for one year, initially causing difficulty in walking long distances and climbing stairs, later requiring a walking stick for ambulation. He also reported tingling pain in both lower limbs without bowel, bladder, bulbar, respiratory, visual, or cognitive involvement. He had a history of lumbar laminectomy following a road traffic accident 18 years earlier and was diagnosed with motor neuron disease two years prior. There was no family history of neuromuscular disorders. Examination revealed hypotonia, distal-predominant weakness (MRC 4/5), fasciculations, and reduced deep tendon reflexes in both lower limbs, with preserved upper limb function. Gait was unsteady with poor balance. MRI showed postoperative changes without spinal cord compression. Nerve conduction studies and electromyography demonstrated selective motor involvement with chronic denervation, consistent with lower motor neuron–predominant motor neuron disease (progressive muscular atrophy phenotype). A multidisciplinary approach with tailored physiotherapy was initiated to preserve functional mobility and quality of life. A goal-oriented physiotherapy intervention plan is detailed in Table 1 . Physiotherapy Management : Table 1 goal-oriented physiotherapy intervention. Sr.no Problem Identified Physiotherapy Goals Intervention Strategies Dosage & Frequency Clinical Rationale 1. Progressive lower limb weakness Maintain existing muscle strength and delay functional decline Low-intensity active and active-assisted strengthening exercises for lower limb muscles 8–10 repetitions, 1–2 sets, once daily Submaximal strengthening helps preserve muscle function without inducing excessive fatigue in MND 2. Muscle hypotonia and wasting Prevent further disuse atrophy Functional task-based exercises and gravity-minimized movements Daily practice during therapy sessions Functional activities promote neuromuscular activation and muscle engagement 3. Reduced endurance and early fatigue Improve activity tolerance Low-intensity endurance training such as slow walking with rest intervals 5–10 minutes with rest breaks, once daily Energy-conserving aerobic activity improves endurance without overexertion 4. Impaired balance and postural control Improve balance and reduce fall risk Static and dynamic balance training in sitting and standing 10–15 minutes per session Balance training enhances postural stability and gait safety 5. Gait instability Improve safe ambulation Gait training with walking stick and therapist supervision Daily gait practice Assistive devices reduce energy cost and improve walking safety 6. Difficulty in transfers and mobility Promote functional independence Bed mobility and transfer training (sit-to-stand, chair transfers) Repeated functional practice Task-specific training improves independence in daily activities 7. Risk of secondary musculoskeletal complications Prevent joint stiffness and pain Active range-of-motion exercises for all major joints 10 repetitions per joint, once daily Maintains joint mobility and prevents contractures 8. Sensory discomfort (tingling) Improve sensory awareness and comfort Sensory re-education techniques and tactile stimulation As tolerated Enhances sensory input and patient comfort 9. Fatigue during daily activities Teach energy conservation Education on pacing, rest periods, and activity modification Ongoing education Reduces fatigue and promotes long-term adherence 10. Need for long-term management Encourage self-management Home exercise program and caregiver education Daily home program Ensures continuity of care and long-term functional maintenance The physiotherapy intervention included therapeutic exercises such as pelvic bridging to improve trunk control and lower limb strength, as illustrated in Fig. 1 . Changes in outcome measures before and after rehabilitation are presented in Table 2 . Outcome Measures and follow -up : Table 2 outcome measures Sr. No. Scales Domain Assessed Pre-Rehabilitation Post-Rehabilitation 1. Manual Muscle Testing (MMT) – Lower Limbs Muscle strength 3/5 bilaterally 4/5 bilaterally 2. Berg Balance Scale (BBS) Static and dynamic balance 18/56 32/56 3. Functional Independence Measure (FIM) Functional independence 65/126 90/126 4. Modified Rankin Scale (mRS) Degree of disability Grade 4 Grade 3 5. Functional Ambulation Category (FAC) Ambulation ability Level 1 Level 3 6. Barthel Index Activities of Daily Living (ADLs) 40/100 70/100 DISCUSSION Motor neuron disease (MND) is a progressive neurodegenerative disorder affecting motor neurons in the brain and spinal cord, leading to combined or isolated upper and lower motor neuron involvement. Among its clinical subtypes, progressive muscular atrophy (PMA) represents a predominantly lower motor neuron (LMN) phenotype, characterized by muscle weakness, wasting, hypotonia, fasciculations, and diminished reflexes without significant upper motor neuron signs ( 8 ). PMA accounts for approximately 5–10% of all MND cases and often presents with distal limb onset, particularly affecting the lower limbs .The current case demonstrated classical LMN-predominant features: progressive bilateral lower limb weakness over one year, hypotonia, fasciculations, and reduced deep tendon reflexes. Sensory involvement was minimal, consistent with the motor neuron–specific pathology, with mild tingling sensations likely secondary to chronic motor unit loss rather than primary sensory nerve involvement.( 2 , 10 ) Electrodiagnostic studies are integral for differentiating MND subtypes and ruling out mimics such as peripheral neuropathy, radiculopathy, or post-surgical deficits. In this patient, nerve conduction studies demonstrated reduced compound muscle action potentials in the peroneal and tibial nerves with preserved sensory nerve action potentials, a hallmark of LMN disease ( 11 ). Needle electromyography revealed a neurogenic pattern with chronic denervation and reinnervation changes, reduced recruitment, and fasciculations, confirming lower motor neuron involvement .( 12 ) These findings align with established diagnostic criteria, including the revised El Escorial and Awaji guidelines, which emphasize electrophysiological confirmation of motor neuron pathology. The presence of previous lumbar laminectomy initially raised the possibility of post-surgical radiculopathy; however, widespread EMG abnormalities beyond the surgical site, preserved sensory conduction, and progressive clinical course supported a diagnosis of LMN-predominant MND rather than focal post-laminectomy deficits .( 7 ) Clinical management of LMN-predominant MND focuses on functional preservation and quality-of-life enhancement rather than disease modification, as no curative therapy exists. Multidisciplinary care is recommended, incorporating neurologists, physiotherapists, occupational therapists, and caregivers ( 13 ). In this case, a structured physiotherapy program was implemented with goals including maintenance of lower limb strength, balance enhancement, gait re-education, endurance optimization, and prevention of secondary complications such as contractures and falls. Exercise intensity was carefully titrated to prevent overfatigue, a crucial consideration in LMN disease due to reduced motor unit reserve and early fatigability. Evidence supports low-intensity, submaximal strengthening and functional task training as safe and beneficial interventions that can slow functional decline without accelerating disease progression. CONCLUSION Motor neuron disease is a progressive neurodegenerative disorder requiring early and accurate diagnosis. Tailored physiotherapy within a multidisciplinary approach helps maintain functional independence and quality of life. Standardized outcome measures are essential for monitoring disease progression and rehabilitation outcomes. Abbreviations · MND – Motor Neuron Disease · LMN – Lower Motor Neuron · UMN – Upper Motor Neuron · ALS – Amyotrophic Lateral Sclerosis · PMA – Progressive Muscular Atrophy · EMG – Electromyography · NCS – Nerve Conduction Study · MRI – Magnetic Resonance Imaging Declarations Ethics approval and consent to participate Ethical approval was obtained from the Institutional Ethics Committee prior to the study. Written informed consent was obtained from the patient before participation in the study. Consent for publication Written informed consent was obtained from the patient for publication of this case report and any accompanying images. All identifying information has been anonymised to maintain confidentiality. Availability of data and materials All data generated or analysed during this study are included in this published article. Competing interests The authors declare that they have no competing interests. Funding This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Authors' contributions Purvi Jadhwani contributed to patient assessment, data collection, physiotherapy intervention, and manuscript drafting. Irshad Qureshi contributed to study conception, clinical supervision, manuscript review, and final approval. All authors read and approved the final manuscript. Acknowledgements Not Applicable Authors' information (optional) Purvi Jadhwani, Intern, Department of Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (DU), Sawangi (Meghe), Wardha, Maharashtra, India. Irshad Qureshi, Principal and Professor, Department of Neuro Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (DU), Sawangi (Meghe), Wardha, Maharashtra, India. References Amyotrophic Lateral Sclerosis | New England Journal of Medicine [Internet]. [cited 2025 Dec 27]. Available from: https://www.nejm.org/doi/full/ 10.1056/NEJMra1603471 Foster LA, Salajegheh MK (2019) Motor Neuron Disease: Pathophysiology, Diagnosis, and Management. Am J Med 132(1):32–37 Awaji Criteria for the Diagnosis of Amyotrophic Lateral Sclerosis A Systematic Review | Amyotrophic Lateral Sclerosis | JAMA Neurology | JAMA Network [Internet]. [cited 2025 Dec 27]. Available from: https://jamanetwork.com/journals/jamaneurology/fullarticle/1309686 Ohashi Y, Tashiro K, Itoyama Y, Nakano I, Sobue G, Nakamura S et al (2001) [Study of functional rating scale for amyotrophic lateral sclerosis: revised ALSFRS(ALSFRS-R) Japanese version]. No Shinkei 53(4):346–355 Cornblath DR, Kuncl RW, Mellits ED, Quaskey SA, Clawson L, Pestronk A et al (1992) Nerve conduction studies in amyotrophic lateral sclerosis. Muscle Nerve 15(10):1111–1115 Ross MA (1997) Acquired motor neuron disorders. Neurol Clin 15(3):481–500 Bello-Haas VD (2018) Physical therapy for individuals with amyotrophic lateral sclerosis: current insights. Degener Neurol Neuromuscul Dis 8:45–54 Cedarbaum JM, Stambler N (1997) Performance of the Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS) in multicenter clinical trials. J Neurol Sci 152(Suppl 1):S1–9 Ren S, Che X, Hu S, Feng X, Zhang J, Shi P (2025) The effect of exercise intervention on amyotrophic lateral sclerosis: a systematic review and meta-analysis. Front Neurol 16:1499407 Liewluck T, Saperstein DS (2015) Progressive Muscular Atrophy. Neurol Clin 33(4):761–773 Riku Y, Atsuta N, Yoshida M, Tatsumi S, Iwasaki Y, Mimuro M et al (2014) Differential motor neuron involvement in progressive muscular atrophy: a comparative study with amyotrophic lateral sclerosis. BMJ Open 4(5):e005213 Daube JR, Rubin DI (2009) Needle electromyography. Muscle Nerve 39(2):244–270 Simmons Z (2013) Rehabilitation of motor neuron disease. Handb Clin Neurol 110:483–498 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8945808","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":595552010,"identity":"0d782b27-8e6a-4ae5-9e65-33aefc54a174","order_by":0,"name":"Purvi Lokesh Jadhwani","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA80lEQVRIiWNgGAWjYLCCBB4Gxg1gRgWQYGZuIEXLGZAWRiK0AAFEC2MbmMSvxVwi95nEAxk72e0Syc8ePJxXG83fDtTyo2IbTi2WM9LNJBJ4ko13zkgzN0jcdjx3xmHGBsaeM7dxajG4kcZskMDDnLjhdoKZROK2Y7kNQC3MjG0EtdQDtaR/k0iccyx3PhFaGB8k8BwGaskB2tJQk7uBkBbLnmcgLceNN9x/UyaRcOxA7kagloP4/GLOnsZw8GdPteyGM8e3Sf6oqcudd/7wwQc/KvA4DEQw9sD5h8HkAZzqYVoYfsD5dfgUj4JRMApGwQgFANc4X5VSR8HdAAAAAElFTkSuQmCC","orcid":"","institution":"Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (DU), Wardha, Maharashtra, India","correspondingAuthor":true,"prefix":"","firstName":"Purvi","middleName":"Lokesh","lastName":"Jadhwani","suffix":""},{"id":595552011,"identity":"a300ff30-e754-40c2-8f05-11df375ce39a","order_by":1,"name":"Irshad Qureshi","email":"","orcid":"","institution":"Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (DU), Wardha, Maharashtra, India","correspondingAuthor":false,"prefix":"","firstName":"Irshad","middleName":"","lastName":"Qureshi","suffix":""}],"badges":[],"createdAt":"2026-02-23 10:15:41","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":true,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":true,"vertebrateSubjectEthicalGuidelines":true},"doi":"10.21203/rs.3.rs-8945808/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8945808/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104399313,"identity":"54eb79f2-f2bc-43ad-aeca-b7a9425cdff7","added_by":"auto","created_at":"2026-03-11 12:05:27","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1354662,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePelvic bridging exercise performed as part of the physiotherapy intervention program.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"image.png","url":"https://assets-eu.researchsquare.com/files/rs-8945808/v1/386ef454947d67b372861607.png"},{"id":104407624,"identity":"663ffa76-cd29-4868-b8e1-30491e6e205c","added_by":"auto","created_at":"2026-03-11 12:39:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1896584,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8945808/v1/a04c7bf0-13e0-4df1-baa9-2193b2048577.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eTailored Physiotherapy Management of Motor Neuron Disease with Predominant Lower Motor Neuron Involvement in a Young Adult: A Case Report\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Key Message","content":"\u003cp\u003eEarly diagnosis and tailored physiotherapy are essential to preserve function and improve quality of life in motor neuron disease.\u003c/p\u003e"},{"header":"INTRODUCTION","content":"\u003cp\u003eMotor neuron diseases (MNDs) constitute a heterogeneous group of progressive neurodegenerative disorders characterized by selective involvement of upper motor neurons (UMNs), lower motor neurons (LMNs), or both, resulting in muscle weakness, atrophy, spasticity, and subsequent functional impairment. Amyotrophic lateral sclerosis is the most common form, accounting for approximately 80\u0026ndash;85% of cases, followed by primary lateral sclerosis, progressive muscular atrophy, and progressive bulbar palsy (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The global prevalence of MND is estimated at 1\u0026ndash;2 per 100,000 population annually, with a higher incidence in males and a typical onset between the fifth and seventh decades of life .Pathologically, MND involves degeneration of motor neurons in the motor cortex, brainstem nuclei, and anterior horn cells of the spinal cord, leading to combined UMN and LMN manifestations (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Clinically, patients present with progressive limb weakness, muscle wasting, fasciculations, spasticity, impaired fine motor control, and, in advanced stages, bulbar and respiratory involvement, which significantly affect prognosis and quality of life (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Although the exact etiology remains unclear, proposed mechanisms include glutamate excitotoxicity, oxidative stress, mitochondrial dysfunction, abnormal protein aggregation, and genetic mutations such as SOD1 and C9orf72 (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) Electrodiagnostic studies, particularly electromyography, are crucial for detecting LMN involvement through neurogenic patterns of chronic denervation and reinnervation, while nerve conduction studies help exclude peripheral neuropathies (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Early diagnosis facilitates timely multidisciplinary management, including physiotherapy, which plays a vital role in preserving function, reducing complications, and improving quality of life using standardized outcome measures.(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)This case report aims to present a detailed clinical, electrophysiological, and physiotherapeutic profile of a patient diagnosed with motor neuron disease demonstrating a neurogenic pattern on EMG, highlighting the role of electrodiagnostic evaluation in diagnosis and the impact of structured physiotherapy intervention on functional outcomes.(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) The report also emphasizes the relevance of appropriate outcome measures in tracking disease progression and rehabilitation efficacy.(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e"},{"header":"CASE REPORT","content":"\u003cp\u003eA middle aged male presented with progressive bilateral lower limb weakness for one year, initially causing difficulty in walking long distances and climbing stairs, later requiring a walking stick for ambulation. He also reported tingling pain in both lower limbs without bowel, bladder, bulbar, respiratory, visual, or cognitive involvement. He had a history of lumbar laminectomy following a road traffic accident 18 years earlier and was diagnosed with motor neuron disease two years prior. There was no family history of neuromuscular disorders.\u003c/p\u003e \u003cp\u003eExamination revealed hypotonia, distal-predominant weakness (MRC 4/5), fasciculations, and reduced deep tendon reflexes in both lower limbs, with preserved upper limb function. Gait was unsteady with poor balance. MRI showed postoperative changes without spinal cord compression. Nerve conduction studies and electromyography demonstrated selective motor involvement with chronic denervation, consistent with lower motor neuron\u0026ndash;predominant motor neuron disease (progressive muscular atrophy phenotype). A multidisciplinary approach with tailored physiotherapy was initiated to preserve functional mobility and quality of life.\u003c/p\u003e \u003cp\u003eA goal-oriented physiotherapy intervention plan is detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cb\u003ePhysiotherapy Management\u003c/b\u003e :\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003egoal-oriented physiotherapy intervention.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSr.no\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProblem Identified\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePhysiotherapy Goals\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIntervention Strategies\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDosage \u0026amp; Frequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eClinical Rationale\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProgressive lower limb weakness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMaintain existing muscle strength and delay functional decline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLow-intensity active and active-assisted strengthening exercises for lower limb muscles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u0026ndash;10 repetitions, 1\u0026ndash;2 sets, once daily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSubmaximal strengthening helps preserve muscle function without inducing excessive fatigue in MND\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMuscle hypotonia and wasting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePrevent further disuse atrophy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFunctional task-based exercises and gravity-minimized movements\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDaily practice during therapy sessions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFunctional activities promote neuromuscular activation and muscle engagement\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReduced endurance and early fatigue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eImprove activity tolerance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLow-intensity endurance training such as slow walking with rest intervals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u0026ndash;10 minutes with rest breaks, once daily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEnergy-conserving aerobic activity improves endurance without overexertion\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImpaired balance and postural control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eImprove balance and reduce fall risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStatic and dynamic balance training in sitting and standing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u0026ndash;15 minutes per session\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBalance training enhances postural stability and gait safety\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGait instability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eImprove safe ambulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGait training with walking stick and therapist supervision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDaily gait practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAssistive devices reduce energy cost and improve walking safety\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDifficulty in transfers and mobility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePromote functional independence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBed mobility and transfer training (sit-to-stand, chair transfers)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRepeated functional practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTask-specific training improves independence in daily activities\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRisk of secondary musculoskeletal complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePrevent joint stiffness and pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eActive range-of-motion exercises for all major joints\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 repetitions per joint, once daily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMaintains joint mobility and prevents contractures\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSensory discomfort (tingling)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eImprove sensory awareness and comfort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSensory re-education techniques and tactile stimulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAs tolerated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEnhances sensory input and patient comfort\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFatigue during daily activities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTeach energy conservation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEducation on pacing, rest periods, and activity modification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOngoing education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eReduces fatigue and promotes long-term adherence\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeed for long-term management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEncourage self-management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHome exercise program and caregiver education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDaily home program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEnsures continuity of care and long-term functional maintenance\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe physiotherapy intervention included therapeutic exercises such as pelvic bridging to improve trunk control and lower limb strength, as illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eChanges in outcome measures before and after rehabilitation are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cb\u003eOutcome Measures and follow -up\u003c/b\u003e :\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eoutcome measures\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSr. No.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eScales\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDomain Assessed\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePre-Rehabilitation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePost-Rehabilitation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eManual Muscle Testing (MMT) \u0026ndash; Lower Limbs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMuscle strength\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3/5 bilaterally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4/5 bilaterally\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBerg Balance Scale (BBS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStatic and dynamic balance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18/56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32/56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFunctional Independence Measure (FIM)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFunctional independence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65/126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e90/126\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModified Rankin Scale (mRS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDegree of disability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGrade 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGrade 3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFunctional Ambulation Category (FAC)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmbulation ability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLevel 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLevel 3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBarthel Index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eActivities of Daily Living (ADLs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40/100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e70/100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eMotor neuron disease (MND) is a progressive neurodegenerative disorder affecting motor neurons in the brain and spinal cord, leading to combined or isolated upper and lower motor neuron involvement. Among its clinical subtypes, progressive muscular atrophy (PMA) represents a predominantly lower motor neuron (LMN) phenotype, characterized by muscle weakness, wasting, hypotonia, fasciculations, and diminished reflexes without significant upper motor neuron signs (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). PMA accounts for approximately 5\u0026ndash;10% of all MND cases and often presents with distal limb onset, particularly affecting the lower limbs .The current case demonstrated classical LMN-predominant features: progressive bilateral lower limb weakness over one year, hypotonia, fasciculations, and reduced deep tendon reflexes. Sensory involvement was minimal, consistent with the motor neuron\u0026ndash;specific pathology, with mild tingling sensations likely secondary to chronic motor unit loss rather than primary sensory nerve involvement.(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eElectrodiagnostic studies are integral for differentiating MND subtypes and ruling out mimics such as peripheral neuropathy, radiculopathy, or post-surgical deficits. In this patient, nerve conduction studies demonstrated reduced compound muscle action potentials in the peroneal and tibial nerves with preserved sensory nerve action potentials, a hallmark of LMN disease (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Needle electromyography revealed a neurogenic pattern with chronic denervation and reinnervation changes, reduced recruitment, and fasciculations, confirming lower motor neuron involvement .(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) These findings align with established diagnostic criteria, including the revised El Escorial and Awaji guidelines, which emphasize electrophysiological confirmation of motor neuron pathology. The presence of previous lumbar laminectomy initially raised the possibility of post-surgical radiculopathy; however, widespread EMG abnormalities beyond the surgical site, preserved sensory conduction, and progressive clinical course supported a diagnosis of LMN-predominant MND rather than focal post-laminectomy deficits .(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eClinical management of LMN-predominant MND focuses on functional preservation and quality-of-life enhancement rather than disease modification, as no curative therapy exists. Multidisciplinary care is recommended, incorporating neurologists, physiotherapists, occupational therapists, and caregivers (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). In this case, a structured physiotherapy program was implemented with goals including maintenance of lower limb strength, balance enhancement, gait re-education, endurance optimization, and prevention of secondary complications such as contractures and falls. Exercise intensity was carefully titrated to prevent overfatigue, a crucial consideration in LMN disease due to reduced motor unit reserve and early fatigability. Evidence supports low-intensity, submaximal strengthening and functional task training as safe and beneficial interventions that can slow functional decline without accelerating disease progression.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eMotor neuron disease is a progressive neurodegenerative disorder requiring early and accurate diagnosis. Tailored physiotherapy within a multidisciplinary approach helps maintain functional independence and quality of life.\u003c/p\u003e \u003cp\u003eStandardized outcome measures are essential for monitoring disease progression and rehabilitation outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u0026middot;\u0026nbsp;MND \u0026ndash; Motor Neuron Disease\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp;LMN \u0026ndash; Lower Motor Neuron\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp;UMN \u0026ndash; Upper Motor Neuron\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp;ALS \u0026ndash; Amyotrophic Lateral Sclerosis\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp;PMA \u0026ndash; Progressive Muscular Atrophy\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp;EMG \u0026ndash; Electromyography\u003c/p\u003e\n\u003cp\u003e\u0026middot;\u0026nbsp;NCS \u0026ndash; Nerve Conduction Study\u003c/p\u003e\n\u003cp\u003e\u0026middot; MRI \u0026ndash; Magnetic Resonance Imaging\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch3\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eEthical approval was obtained from the Institutional Ethics Committee prior to the study. Written informed consent was obtained from the patient before participation in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for publication of this case report and any accompanying images. All identifying information has been anonymised to maintain confidentiality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePurvi Jadhwani contributed to patient assessment, data collection, physiotherapy intervention, and manuscript drafting.\u003c/p\u003e\n\u003cp\u003eIrshad Qureshi contributed to study conception, clinical supervision, manuscript review, and final approval.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' information (optional)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePurvi Jadhwani, Intern, Department of Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (DU), Sawangi (Meghe), Wardha, Maharashtra, India.\u003cbr\u003e\u0026nbsp;Irshad Qureshi, Principal and Professor, Department of Neuro Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (DU), Sawangi (Meghe), Wardha, Maharashtra, India.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAmyotrophic Lateral Sclerosis | New England Journal of Medicine [Internet]. [cited 2025 Dec 27]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.nejm.org/doi/full/\u003c/span\u003e\u003cspan address=\"https://www.nejm.org/doi/full/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1056/NEJMra1603471\u003c/span\u003e\u003cspan address=\"10.1056/NEJMra1603471\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFoster LA, Salajegheh MK (2019) Motor Neuron Disease: Pathophysiology, Diagnosis, and Management. Am J Med 132(1):32\u0026ndash;37\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAwaji Criteria for the Diagnosis of Amyotrophic Lateral Sclerosis A Systematic Review | Amyotrophic Lateral Sclerosis | JAMA Neurology | JAMA Network [Internet]. [cited 2025 Dec 27]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://jamanetwork.com/journals/jamaneurology/fullarticle/1309686\u003c/span\u003e\u003cspan address=\"https://jamanetwork.com/journals/jamaneurology/fullarticle/1309686\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOhashi Y, Tashiro K, Itoyama Y, Nakano I, Sobue G, Nakamura S et al (2001) [Study of functional rating scale for amyotrophic lateral sclerosis: revised ALSFRS(ALSFRS-R) Japanese version]. No Shinkei 53(4):346\u0026ndash;355\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCornblath DR, Kuncl RW, Mellits ED, Quaskey SA, Clawson L, Pestronk A et al (1992) Nerve conduction studies in amyotrophic lateral sclerosis. Muscle Nerve 15(10):1111\u0026ndash;1115\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoss MA (1997) Acquired motor neuron disorders. Neurol Clin 15(3):481\u0026ndash;500\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBello-Haas VD (2018) Physical therapy for individuals with amyotrophic lateral sclerosis: current insights. Degener Neurol Neuromuscul Dis 8:45\u0026ndash;54\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCedarbaum JM, Stambler N (1997) Performance of the Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS) in multicenter clinical trials. J Neurol Sci 152(Suppl 1):S1\u0026ndash;9\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRen S, Che X, Hu S, Feng X, Zhang J, Shi P (2025) The effect of exercise intervention on amyotrophic lateral sclerosis: a systematic review and meta-analysis. Front Neurol 16:1499407\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiewluck T, Saperstein DS (2015) Progressive Muscular Atrophy. Neurol Clin 33(4):761\u0026ndash;773\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRiku Y, Atsuta N, Yoshida M, Tatsumi S, Iwasaki Y, Mimuro M et al (2014) Differential motor neuron involvement in progressive muscular atrophy: a comparative study with amyotrophic lateral sclerosis. BMJ Open 4(5):e005213\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDaube JR, Rubin DI (2009) Needle electromyography. Muscle Nerve 39(2):244\u0026ndash;270\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSimmons Z (2013) Rehabilitation of motor neuron disease. Handb Clin Neurol 110:483\u0026ndash;498\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (DU), Wardha, Maharashtra, India","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Motor neuron disease, Progressive muscular atrophy, Lower motor neuron, Electromyography, Amyotrophic lateral sclerosis","lastPublishedDoi":"10.21203/rs.3.rs-8945808/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8945808/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eMotor neuron disease (MND) is a progressive neurodegenerative disorder involving degeneration of upper and/or lower motor neurons, resulting in muscle weakness and functional decline. Progressive muscular atrophy (PMA) represents a lower motor neuron\u0026ndash;predominant phenotype within the MND spectrum and commonly presents with distal limb weakness and progressive disability.\u003c/p\u003e\u003ch2\u003eObjective:\u003c/h2\u003e \u003cp\u003eTo describe the clinical, electrophysiological, and functional outcomes of a young adult with lower motor neuron\u0026ndash;predominant motor neuron disease managed with tailored physiotherapy rehabilitation.\u003c/p\u003e\u003ch2\u003eMethods and Materials:\u003c/h2\u003e \u003cp\u003eA middle aged male with progressive bilateral lower limb weakness for one year and tingling sensations for six months was evaluated clinically and electrophysiologically. He had a prior history of lumbar laminectomy following a road traffic accident and was a known case of MND. Assessment included neurological examination and electromyography, which demonstrated a neurogenic pattern consistent with predominant lower motor neuron involvement. A structured, goal-oriented physiotherapy program focusing on strength maintenance, balance training, gait re-education, and functional mobility was implemented.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003ePost-rehabilitation assessment revealed improvement in balance, ambulation, functional independence, and activities of daily living, with stabilization of muscle strength and improved gait safety.\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003eEarly diagnosis and individualized physiotherapy intervention play a crucial role in preserving functional abilities and improving quality of life in patients with lower motor neuron\u0026ndash;predominant motor neuron disease.\u003c/p\u003e","manuscriptTitle":"Tailored Physiotherapy Management of Motor Neuron Disease with Predominant Lower Motor Neuron Involvement in a Young Adult: A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-27 07:31:51","doi":"10.21203/rs.3.rs-8945808/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1e851216-8e98-4e1a-959f-b95c0219265e","owner":[],"postedDate":"February 27th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":63524605,"name":"Neurosurgery"}],"tags":[],"updatedAt":"2026-02-27T07:31:51+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-27 07:31:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8945808","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8945808","identity":"rs-8945808","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}