Comprehensive Rehabilitation in Systemic Sclerosis with Complex Neurological Involvement: A Case Report Short running title: Complex Systemic Sclerosis Rehabilitation

Abstract

Introduction: Systemic sclerosis (SSc) is a chronic autoimmune disorder characterized by fibrosis and vascular dysfunction affecting multiple organ systems. Neurological and pulmonary complications, though less common, can markedly worsen disability and impair quality of life. Multidisciplinary rehabilitation plays a crucial role in optimizing function, yet evidence in complex SSc cases remains limited.
Case Presentation: A 65-year-old woman with known SSc developed progressive rigidity, mixed axonal–demyelinating polyneuropathy confirmed by electrodiagnostic studies, interstitial lung disease with an NSIP pattern on HRCT, and significant nutritional decline. She presented with bedridden status, marked balance impairment, stocking–glove sensory loss, digital ischemia, poor exercise tolerance, and complete dependence in mobility and self-care. An individualized inpatient rehabilitation program was initiated, including gradual mobility and strengthening exercises, adaptive self-care training, pulmonary rehabilitation, nutritional optimization, and psychological support. Over several weeks, she demonstrated measurable improvements in supervised ambulation with a walker, independence in daily activities, reduction of neuropathic symptoms, enhanced nutritional intake, and improved sleep.
Discussion: This case illustrates the compounded functional burden imposed by the coexistence of neurological and pulmonary manifestations in SSc. Polyneuropathy further limits mobility, while interstitial lung disease contributes to fatigue, dyspnea, and exercise intolerance. The patient’s meaningful gains highlight the importance of early, coordinated rehabilitation approaches tailored to multisystem impairment. Strengthening, balance retraining, pulmonary conditioning, and nutritional support can produce synergistic benefits, even in severe disease stages.
Conclusion: Comprehensive, individualized multidisciplinary rehabilitation can substantially enhance functional outcomes and quality of life in patients with systemic sclerosis complicated by neurological and pulmonary involvement. Early referral and integrated management are essential to mitigate disability and optimize recovery.
Keywords: systemic sclerosis; polyneuropathy; interstitial lung disease; rehabilitation; functional recovery