Effect of an integrated exercise programme and use of electromyography to track chronic functional recovery after hemorrhagic stroke: A case report

Background: Hemorrhagic stroke often results in persistent motor impairments and functional dependence, particularly in chronic stages where recovery is usually considered limited. Emerging evidence suggests that intensive, task-oriented rehabilitation combined with objective neuromuscular monitoring may enhance long-term functional outcomes by promoting neuroplastic adaptations. Case description and management: A 56-year-old women with left-sided hemiplegia following a hemorrhagic stroke in 2015 presented with significant motor deficits and reduced functional independence despite prior conventional rehabilitation. Ten years post-stroke (March 2025), she continued to experience spasticity, impaired mobility, and difficulty performing activities of daily living. Baseline assessment revealed low Functional Independence Measure (FIM) scores, increased muscle tone on the Modified Ashworth Scale (MAS), and reduced neuromuscular activation on electromyograph. The patient underwent a structured 15-week integrated physiotherapy programme, consisting of high-intensity sessions conducted six days per week. The intervention included task-specific functional training, strengthening, balance and gait training, spasticity management techniques, and oromotor and facial muscle stimulation. Electromyography was used to objectively monitor changes in muscle activation and motor unit recruitment throughout the rehabilitation period. Following the intervention, the patient demonstrated meaningful improvements in functional independence, reduced spasticity, and enhanced neuromuscular activation, as reflected by improved FIM, MAS, and electromyographic outcomes. Conclusion: This case highlights that significant functional recovery and neuromuscular adaptation remain achievable even in the chronic phase of hemorrhagic stroke through an intensive, integrated rehabilitation approach supported by objective assessment tools.