Clinical Sciences/Health Conditions
Richard M. Martinez, Jr., MD
PGY2 Resident
UTHSCSA/ PM&R
San Antonio, Texas, United States
Robin Jacob, M.D.
PGY2 Resident
UTHSCSA/PM&R
San Antonio, Texas, United States
Michael Bejarano, DO
PGY2 Resident
VCU/ PMR
Richmond, Virginia, United States
Blaise Langan, DO
Attending / Medical Director of Reeves Rehabilitation Center
UTHSCSA / PM&R
San Antonio, Texas, United States
A 57-year-old woman with diabetes, hypertension, prior stroke with residual right-sided weakness, and a recent left fifth metatarsal fracture presented to the emergency department with progressive right hemiparesis, facial droop, and dysarthria. Initially suspected to have recurrent stroke, imaging revealed an enhancing mass involving the left cerebral peduncle and thalamic nuclei. Stereotactic biopsy confirmed primary CNS large B-cell lymphoma, with spinal imaging demonstrating leptomeningeal involvement.
At hospital admission, she was non-ambulatory and required maximal assistance for transfers and activities of daily living (ADLs), representing significant functional decline from premorbid status. Before initiation of high-dose chemotherapy, she was admitted to inpatient rehabilitation for structured prehabilitation emphasizing strength, bed mobility, transfers, wheelchair mobility, and compensatory ADL strategies. During this period, she progressed to independent bed mobility, supervision-level transfers, and minimal-assist wheelchair propulsion, improving safety, reducing care burden, and enabling timely chemotherapy initiation. This case illustrates a seldom-captured process that may prove essential to the field of neuro-oncological intervention. It provides evidence for a significant role to be filled by rehab specialists. With a focus on preservation and maintaining independence, our team demonstrates the timely initiation of chemotherapy for a prepared individual, despite complex comorbidities and presenting functional limitations.
Discussions: Prehabilitation is an impairment-driven rehabilitation strategy applied between diagnosis and definitive oncologic treatment to prevent functional decline and enhance treatment readiness. While prehabilitation is well described in surgical oncology, its role in neuro-oncology patients undergoing chemotherapy is less established. This is especially true in literature related to primary lymphoma.
Conclusions:
