Stage-Dependent Physiotherapy for Recovery From Supplementary Motor Area Syndrome: A Case Report

Supplementary motor area (SMA) syndrome is a postoperative complication following SMA tumor resection, characterized by delayed movement initiation and impaired bimanual coordination. Although spontaneous recovery is common, rehabilitation strategies tailored to recovery stages remain unclear. We report a 38-year-old woman who presented with a right SMA tumor (isocitrate dehydrogenase-mutant oligodendroglioma). Preoperatively, she was independent in activities of daily living (ADLs) with no motor, sensory, or cognitive impairments. She underwent awake craniotomy with intraoperative monitoring confirming preservation of the primary motor cortex and corticospinal tract. On postoperative day (POD) 1, she developed left hemiparesis, delayed movement initiation, and impaired bimanual coordination, consistent with SMA syndrome. The patient received inpatient physical and occupational therapy (2 hours/day, 5 days/week) for 3 weeks. Balance and gait training were combined with progressively introduced bilateral, alternating, and rhythmic tasks emphasizing motor timing, sequencing, and coordination based on functional recovery stages. On POD 1, the Brunnstrom Recovery Stage (BRS) was III for the upper limb and II for the lower limb. By POD 14, BRS improved to VI and V, and she achieved independence in ward-based ADLs. Gait speed increased from 1.1 to 1.2 m/s, hand function improved from 91 to 98, and bimanual Purdue Pegboard Test performance improved from 7.3 to 10.3 pairs. By POD 22, gait speed reached 1.4 m/s and the Berg Balance Scale score was 56. This case demonstrates the stage-dependent evolution of SMA syndrome and suggests the potential utility of rehabilitation approaches emphasizing coordinated and sequential motor tasks aligned with functional recovery.