Abstract Number: Esoc2026a1950 Personalized Rehabilitation and Occupational Advice Using Transcranial Doppler in a Case of a Nadaswaram Player With Acute Ischemic Stroke

Abstract Background Standardized stroke rehabilitation protocols often emphasize broad motor and cognitive recovery but may overlook the unique occupational challenges. The Nadaswaram, a traditional South Indian wind instrument, requires sustained diaphragmatic breathing, circular breathing , fine motor control, precise timing and varying neck postures. In a post stroke patient this can cause hemodynamic changes which can potentially compromise cerebral perfusion Transcranial Doppler (TCD) ultrasonography, by monitoring real-time cerebral blood flow dynamics can be a useful tool for tailoring rehabilitation and safely reintegrating occupational tasks. Aim To illustrate the use of TCD in guiding rehabilitation and occupational reintegration in a professional Nadaswaram player following acute ischemic stroke. Methods We present the case of a Nadaswaram player with a left lateral medullary infarct and vertebral artery narrowing. The patient showed symptomatic improvement over two weeks but expressed concern about safely resuming professional performance. Using TCD, we monitored peak and mean vertebral artery flow velocities at baseline and during Nadaswaram playing. Results TCD recordings demonstrated that flow velocities did not exceed critical thresholds during performance. Also these velocities were maintained with all the neck positions required for playing the instrument. Based on these findings, the patient was reassured and advised to gradually resume Nadaswaram playing. The patient confidently resumed his profession without any subsequent vascular events. Conclusions This case highlights the value of TCD-guided, occupation-specific rehabilitation in aligning recovery . Such personalized approaches may enhance safety, motivation, and functional recovery, particularly in individuals whose livelihoods depend on highly specialized skills. Conflict of interest Sanjith Aaron, Prabakhar AT and Venketswara Reddy has nothing to disclose