Physiotherapy Rehabilitation in Organophosphate Poisoning: A Case Report of Sensory-motor Axonal Polyneuropathy with Hyperesthesia

Abstract

Background: Organophosphate poisoning (OPP) is a major health concern in agricultural communities, often leading to acute systemic complications and delayed neuropathy. Physiotherapy plays a vital role in recovery, though evidence for late-stage rehabilitation remains limited. Case Presentation: A 24-year-old farmer presented unconscious after pesticide exposure, with cholinergic crisis and respiratory failure. Acute complications include renal dysfunction, gastrointestinal bleeding, and ventilator-associated pneumonia. By week four, he developed sensory-motor axonal polyneuropathy with severe hyperesthesia and immobility. Intervention: A phased physiotherapy program was implemented. Early management emphasized respiratory care through bronchial hygiene, suctioning, and chest mobilization. As sensorium improved, graded mobility training, upper limb strengthening, and postural exercises were introduced. Sensory disturbances were addressed with structured desensitization using varied textures and graded exposure. Cryotherapy provided short-term relief, while TENS was discontinued due to pain aggravation. Lower limb strengthening was initiated once hyperesthesia subsided. Outcomes: After seven weeks, GCS improved to 15/15, Barthel Index to 80/100, and pain reduced to VAS 4/10. Functional independence progressed to minimal assistance. Conclusion: Structured physiotherapy combining respiratory, mobility, strengthening, and sensory modulation significantly enhanced recovery in OPP-induced delayed neuropathy.