Functioning and Disability
Nilla mayasari, MD
Physical Medicine and Rehabilitation Specialist
Wahidin Sudirohusodo Hospital
Makassar, Sulawesi Selatan, Indonesia
Diah Nurul Islami Muchsin, MD
Physical Medicine and Rehabilitation Resident
Hasanuddin University
Makassar, Sulawesi Selatan, Indonesia
Bland–White–Garland syndrome, also known as anomalous left coronary artery from the pulmonary artery (ALCAPA), is a rare congenital heart disease that can result in impaired cardiopulmonary endurance, physical deconditioning, and participation restrictions. Access to continuous rehabilitation is often limited in patients from low resource setting and rural areas, making alternative rehabilitation approaches such as telerehabilitation increasingly relevant.
Case Description: An adolescent female with Bland–White–Garland syndrome, accompanied by amenorrhea and malnutrition, was referred for rehabilitation two months after corrective cardiac surgery. She presented with intermittent sternal pain, exertional dyspnea when walking more than 100 meters, easy fatigability, postural disturbance, and upper trapezius muscle spasm. Although independent in basic activities of daily living, reduced exercise tolerance led to participation restrictions, including reliance on online schooling and limited social interaction. The patient lived in a rural area and came from a low-resources family with limited access to hospital-based rehabilitation. Therefore, a hybrid rehabilitation program combining outpatient supervision and telerehabilitation was implemented. Aerobic capacity was evaluated using the six-minute walk test (6MWT).
Discussions:
Baseline assessment showed a 6MWT distance of 360 meters (70.9% of predicted) and a functional capacity of 3.9 METs, indicating reduced cardiopulmonary endurance. Following a structured rehabilitation program consisting of breathing exercises, inspiratory muscle training, posture correction, progressive aerobic exercise, and patient education delivered partly through telerehabilitation, the 6MWT distance improved to 395 meters, with functional capacity increasing to 4.48 METs. Oxygen saturation and perceived exertion remained stable, indicating safe and effective training. Cognitive assessment using an intelligence quotient (IQ) test was planned to support return-to-school readiness.
Conclusions:
Individualized rehabilitation supported by telerehabilitation can effectively improve functional capacity and reduce participation restrictions in adolescents with Bland–White–Garland syndrome, particularly in low-resource and rural settings, facilitating return to school and social reintegration.
