Multimodal rehabilitation in PLP1-associated spastic paraparesis: a case report with clinical and biomechanical outcomes.
Mirjam Bonanno, Mauro Botindari, Antonino Lombardo Facciale and 3 others
In one man with PLP1-related spastic paraparesis, a 20-session program of anti-gravity treadmill training plus wearable electrical stimulation was feasible.
Balance and strength improved by the end, but walking speed and endurance dipped after the first block before partially recovering.
Key findings
1Balance (Berg Balance Scale) improved from 35 to 39, and lower limb strength (Motricity Index) improved from 44 to 56 on the right and from 52 to 56 on the left by the end of the program.
2Gait-related measures followed a non-linear course: the 10-meter walk test went from 11.22 to 17.52 to 12.72 seconds, and the 6-minute walk test from 150 to 125 to 145 meters, with worsening after the first block and partial recovery by the end.
3The program was feasible and well-tolerated, with stable oxygen saturation and no clinically relevant cardiovascular instability across both treatment blocks.
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What it does not show
One patient. Nothing here generalises beyond this individual's response. No control condition, no washout, no randomisation. The two blocks were sequential, so you cannot tell whether the treadmill progression, the electrical stimulation, the cumulative training dose, or natural variability drove any given change. Fatigue scales were only measured during the second block, so there is no true baseline for those outcomes. The patient had already received regular physiotherapy, botulinum toxin injections (300 U in 2024), and obturator nerve neurotomy (2021). Any of these could have influenced his motor performance and adaptation during the 20 sessions. No follow-up assessment after the program ended, so there is no information on whether any of the changes lasted. The minimal detectable change values used for context come from stroke and other populations, not from PLP1-related spastic paraparesis, so the comparisons are exploratory at best.
Declared interests
Funded by the Italian Ministry of Health (Current Research Funds 2026, RRC-2026-23688274). No industry sponsor, no device manufacturer involvement in design or writing is declared. The two devices used (Alter-G, EXOPULSE Mollii Suit) are commercial products, but the paper does not state that either company funded or influenced the work.
The easy way to misread this
Do not read the balance and strength gains as evidence that the anti-gravity treadmill or the electrical stimulation caused them. This is one patient with no control condition, and the authors state that the contribution of each component cannot be separated and that causal inference is not possible. The non-linear gait pattern (worsening at T1, partial recovery at T2) should not be read as the program being harmful, nor should the end-of-program values be read as proof of lasting benefit, since no follow-up was done.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →