Challenges in Rehabilitation of a Tetanus Patient With Severe Complications

Tetanus is a rare but life-threatening neurological disorder caused by neurotoxins produced by Clostridium tetani. Although mortality rates have significantly decreased with modern intensive care, severe cases remain challenging due to prolonged Intensive Care Unit (ICU) stays, complications, and rehabilitation barriers. We report the case of an 81-year-old male with a history of hypertension and femoral neck fracture who developed severe tetanus following a contaminated forehead laceration. Despite appropriate wound management, symptoms progressed rapidly, including trismus, generalized muscle spasms, opisthotonus, and respiratory failure requiring mechanical ventilation. Rehabilitation therapy began on the 10th day of hospitalization and focused on positioning techniques and passive range-of-motion exercises to reduce opisthotonus, preserve joint mobility, and prevent contractures. However, complications such as pneumonia, septic shock, and autonomic instability led to interruptions in therapy. By transfer on the 80th day, muscle tone had improved (Adductor Tone Rating: 2→1), and functional independence, measured by the Barthel Index, reached 10 points. Despite persistent spasticity in the upper limbs and finger contractures, early rehabilitation and multidisciplinary collaboration mitigated further functional decline. This case highlights the importance of initiating tailored rehabilitation early, even amidst life-saving interventions, to address the unique complexities of severe tetanus and prevent secondary complications such as disuse syndrome.