Background: The benefits of pre-operative habilitation or “prehabilitation” for total knee arthroplasty outcomes have been documented and researched over the last twenty years. However, the majority of these studies do not describe prehabilitation programs for patients with complex neurologic comorbidities. Purpose: The purpose of this case report is to describe clinical decisions made during the course of a prehabilitation program for a patient with a cerebellar disorder and bony malformation at her knee. Case Description: The patient was diagnosed with excessive tibial torsion when she was 60 years old and a year later diagnosed with uterine cancer and paraneoplastic cerebellar degeneration. The patient currently shows significant genu valgum at her right lower extremity and ambulates using a four wheeled walker, bilateral knee braces donned, and has an ataxic gait. Her goals for therapy are to improve her strength as she anticipates having a total knee arthroplasty, improve her balance, and stay active. Outcome Measures: Timed Up and Go (TUG), Berg Balance Scale, Dynamometer, as well as mass of weights lifted were used as outcome measures. Discussion: Low-load, high repetition and open kinetic chain movements were optimal means of strengthening for this particular patient, addressing both bony malformation and neurologic deficits. Additionally, the patient’s Timed Up and Go and Berg Balance Scale showed meaningful changes, possibly in part because the patient had good afferent signaling, but also because of the large amounts of time the patient dedicated to rehabilitation
