Rehabilitation Strategy Guided by Physiological Indicators in a Patient With Tetanus and Multiple Fractures: A Case Report

Tetanus is a serious infectious disease characterized by muscle rigidity and autonomic storm. In severe cases, long-term deep sedation is required, resulting in a high risk of post-intensive care syndrome (PICS). However, criteria for determining the timing of early rehabilitation intervention have not yet been established. We report the case of a woman in her 70s who developed tetanus following a wood-splinter injury to her right forearm and subsequently suffered bilateral humeral fractures due to muscle rigidity and convulsions. She was admitted to the intensive care unit (ICU) with an Ablett classification of Grade III, which progressed to Grade IV following ICU admission. On Day 11, rehabilitation was initiated after confirming the resolution of muscle hypertonicity and opisthotonos, a downward trend in creatine kinase (CK) levels, and the stabilization of hemodynamic parameters. No apparent recurrence of autonomic symptoms was observed during rehabilitation. The patient was gradually mobilized from edge-of-bed sitting to wheelchair use, and then to standing and walking. With multidisciplinary collaboration, she was discharged home on Day 114. The findings from this case may provide a basis for determining the timing of safe rehabilitation intervention in patients with severe tetanus.