Rehabilitation in a Patient with Spastic Quadriplegia and Pneumonia: The Physiatrist’s Point of View Through the Analysis of a Case Report

Patients with severe neurological sequelae often experience profound motor deconditioning that, combined with impaired mucociliary clearance, reduced lung volume, and the presence of tracheostomy, predisposes them to pulmonary infections and serious respiratory complications. A 24-year-old male with spastic quadriplegia secondary to childhood cerebral hemorrhage from an arteriovenous malformation, tracheostomy with a cuffed cannula under mechanical ventilation, and hydrocephalus treated with a ventriculoperitoneal shunt, presented to the emergency department with fever unresponsive to paracetamol and ceftriaxone. Laboratory tests showed markedly elevated inflammatory indices (C-reactive protein 249.3 mg/dl), and chest computed tomography revealed extensive consolidation of the left lower lobe with an air bronchogram and endobronchial obstruction, consistent with aspiration pneumonia. Fibrobronchoscopy confirmed the presence of endobronchial material, and culture grew Acinetobacter baumannii. Given the patient’s clinical and functional status, the physiatrists prescribed an Individual Rehabilitation Project (motor and respiratory re-educational programs, including passive mobilization of major joints, cautious trunk stabilization, and lung volume recruitment maneuvers) to support the effects of positive-pressure ventilation. The case underscores the dual challenge of neurological impairment and pulmonary vulnerability, where immobilization further exacerbates respiratory compromise and infection risk, fostering sarcopenia and poor quality of life. In patients with spastic quadriplegia of cerebrovascular origin on long-term mechanical ventilation, a synergistic approach combining NIV optimization and individualized motor-respiratory rehabilitation may represent an effective strategy to control recurrent infections and maintain clinical stability. In this area, there is currently insufficient evidence, and urgent future research is needed.