Occupational Therapy in Acute Branch Atheromatous Disease With Frequent Motor Paralysis Fluctuations: A Case Report

Branch atheromatous disease (BAD) often progresses during the acute phase. During acute rehabilitation, clinicians should prioritize monitoring neurological symptom progression. We treated a patient with right-sided, finger-limited motor paralysis and frequent transient motor paralysis fluctuations due to BAD by implementing early upper-limb occupational therapy while maintaining rigorous risk management. Occupational therapy included standard upper limb functional training, continuous neuromuscular electrical stimulation, and repetitive facilitation exercises. During occupational therapy, blood pressure was carefully monitored, and neurological symptoms were regularly assessed. Any symptom changes were promptly communicated among occupational therapists, rehabilitation specialists, and neurosurgeons. Although transient motor paralysis occurred five times, timely treatment, including medication adjustments, prevented further neurological deterioration. Additionally, upper-limb function and object manipulation ability improved over time. Risk management is critically important in occupational therapy for acute BAD. This case demonstrated that repetitive facilitation exercises combined with continuous neuromuscular electrical stimulation can be safely initiated in the early stages of stroke, potentially improving upper limb dysfunction.