Case Report: An MDT-guided multimodal protocol for large-area stroke plateau — integrating neuromodulation with multimodal assessment

Objective This case report investigates the feasibility and potential value of an individualized precision rehabilitation protocol for large-area stroke, integrating multimodal neuromodulation under the guidance of a multidisciplinary team (MDT) and dynamic assessment. Methods A 38-year-old male with right hemiplegia and global aphasia following large left hemispheric infarction underwent an 8-month MDT-managed program. A closed-loop “assess-decide-intervene-re-assess” framework was implemented, featuring periodic multimodal evaluations (clinical scales, DTI, fMRI, EEG, 3D gait analysis). The intervention dynamically combined conventional therapy with staged neuromodulation: repetitive Transcranial Magnetic Stimulation (rTMS) for aphasia and intermittent Theta Burst Stimulation (iTBS) for motor disorder, Brain-Computer Interface (BCI)-robotic training and task-oriented Virtual Reality (VR) for upper limb function, and biomechanical correction with custom insoles based on gait analysis. Results Notable functional improvements were observed: LOTCA increased by 16 points, CRRCAE subscale improved by 60%–90%, FMA increased from 20 to 56, FMA-B reached 12, and MBI improved from 40 to 91. Neuroimaging revealed increased fractional anisotropy (FA) in the corpus callosum and right corticospinal tract, and elevated ALFF/ReHo in right frontal-temporal areas. Event-related desynchronization (ERD) decreased during BCI training, and gait parameters improved. Conclusion In this patient with large-area stroke who showed limited response to conventional rehabilitation, an MDT-guided, dynamically adjusted multimodal intervention was temporally associated with concurrent recovery across cognitive, language, motor, and daily living domains. The concomitant neural changes suggest possible trans-hemispheric network reorganization. These observations are hypothesis-generating and, while limited by the single-case design, provide a preliminary rationale for future investigations into precision neurorehabilitation approaches in similar complex cases. Clinical trial registration ChiCTR2300069203.