Precision Balance Rehabilitation in Progressive Multifocal Leukoencephalopathy: A Novel Case Report

Background and Purpose: Progressive Multifocal Leukoencephalopathy (PML) is a demyelinating disease of white matter, primarily affecting immunocompromised patients. PML survivors often experience disability marked by ataxia and balance deficits. Rehabilitation research for this population is limited. This case report describes the design, application, and efficacy of a balance rehabilitation program for a patient with PML. Case Description: A 62-year-old male with a history of HIV-associated PML presented with lesions in the left occipital lobe and left cerebellum on MRI. Computerized Dynamic Posturography (CDP) revealed deficits in visual and vestibular sensory integration, limits of stability, and perturbation recovery. Intervention: The intervention combined CDP-based training with overground and home exercise components. Nine balance training sessions were completed over 5 weeks. Sessions were tailored to the patient’s deficits and progressively adjusted for intensity and focus based on the patient’s performance. Outcomes: Post-intervention testing demonstrated measurable improvements and reduction of risk for falling in the following outcomes: 1) Mini-Best test 23/28 (pre) increased to 27/28 (post), 2) Sensory Organization Test composite equilibrium score 29 (pre) increased to 51 (post), and 3) Limits of Stability maximal excursion improved by over 20% in the forward and left directions. The patient also reported improvements in balance-related confidence, with an Activities-specific Balance Confidence Scale score that increased from 65.6% (pre) to 69.4% (post). Discussion: Analysis of posturography data guided the design of a personalized balance intervention integrating CDP, overground training, and home exercise. The patient’s positive response to this targeted, precision approach underscores the potential for meaningful balance improvements in individuals with PML, even in the presence of cerebellar damage. Keywords: progressive multifocal leukoencephalopathy, postural balance, virtual reality, rehabilitation, cerebellar disorder