Integration of pan-omics technologies and three-dimensional in vitro tumor models: an approach toward drug discovery and precision medicine.

Despite advancements in treatment protocols, cancer is one of the leading cause of deaths worldwide. Therefore, there is a need to identify newer and personalized therapeutic targets along with screening technologies to combat cancer. With the advent of pan-omics technologies, such as genomics, transcriptomics, proteomics, metabolomics, and lipidomics, the scientific community has witnessed an improved molecular and metabolomic understanding of various diseases, including cancer. In addition, three-dimensional (3-D) disease models have been efficiently utilized for understanding disease pathophysiology and as screening tools in drug discovery. An integrated approach utilizing pan-omics technologies and 3-D in vitro tumor models has led to improved understanding of the intricate network encompassing various signalling pathways and molecular cross-talk in solid tumors. In the present review, we underscore the current trends in omics technologies and highlight their role in understanding genotypic-phenotypic co-relation in cancer with respect to 3-D in vitro tumor models. We further discuss the challenges associated with omics technologies and provide our outlook on the future applications of these technologies in drug discovery and precision medicine for improved management of cancer.

Targeted blockade of interleukin-8 negates metastasis and chemoresistance via Akt/Erk-NFκB axis in oral cancer.

BACKGROUND: The tumor microenvironment plays a significant role in tumor growth, metastasis and chemoresistance via dysregulated signaling pathways. Toward this, an inflammatory chemokine, interleukin-8 (IL-8), is overexpressed in various cancers and is involved in tumor progression and chemoresistance. However, the mechanistic role of IL-8 in mediating metastasis and chemoresistance in oral squamous cell carcinoma (OSCC) is not known. METHODS AND RESULTS: In the present study, we evaluated the effect of IL-8 in regulating metastasis as well as chemoresistance in OSCC cell lines. For this, IL-8 was blocked exogenously using neutralizing IL-8 monoclonal antibody and IL-8 levels were enhanced by exogenous supply of recombinant human IL-8 (rhIL-8) to OSCC cells. The epithelial-to-mesenchymal transition (EMT) was evaluated using qPCR, migration by scratch/wound healing assay and invasion ability using transwell assay. rIL-8 induced chemoresistance was studied by apoptosis assay and the nuclear localization of NFκB using immunocytochemistry. IL-8 was significantly overexpressed in OSCC patients and cell lines. While exogenous blockade of IL-8 significantly reduced EMT, migration and invasion potential in OSCC cells, IL-8 overexpression upregulated these cellular traits thereby confirming the role of IL-8 in OSCC metastasis. Exogenous blockade of IL-8 also reversed chemoresistance in cisplatin resistant OSCC subline via NFκB signaling. CONCLUSION: IL-8 plays a crucial role in OSCC metastasis and its targeted blockade can help in management of cisplatin resistance.

Epithelial cell adhesion molecule (EpCAM) binding short peptides derived from antibody MOC-31; De-novo design, synthesis and their in-vitro evaluation.

Epithelial cell adhesion molecule (EpCAM) is one of the critical bio-maker for circulating tumor cells (CTC) detection. For capturing CTC, antibody-antigen-based techniques have mainly been explored. However, the expensiveness and tedious manufacturing process have posed certain limitations for antibody-based techniques for its wide applications in cell capturing. On the other hand, peptides are inexpensive bimolecular probes with high specificity and tunability. Although there are few reports on EpCAM binding peptides are available in literature, those peptides were selected through random library screening. Interestingly, de-novo design of the peptides against EpCAM has not been reported till date. For the first time, we have developed a small peptide (Pep14) from the complementary derived region (CDRs) of antibody MOC31 through systematic virtual screening. Selected peptide has demonstrated good binding affinity towards EpCAM with dissociation constant (Kd) of 870 nM and found to be co-localized with the anti-EpCAM antibody in EpCAM expressing cancer cells (MCF-7). Therefore, the short peptide Pep14 hold promise for capturing circulatory tumor cells through EpCAM binding.

Mesenchymal Stem Cell-Derived Exosomes Loaded with miR-155 Inhibitor Ameliorate Diabetic Wound Healing.

Diabetic wounds are one of the debilitating complications that affect up to 20% of diabetic patients. Despite the advent of extensive therapies, the recovery rate is unsatisfactory, and approximately, 25% of patients undergo amputation, thereby demanding alternative therapeutic strategies. On the basis of the individual therapeutic roles of the miR-155 inhibitor and mesenchymal stem cells (MSC)-derived exosomes, we conjectured that the combination of the miR-155 inhibitor and MSC-derived exosomes would have synergy in diabetic wound healing. Herein, miR-155-inhibitor-loaded MSC-derived exosomes showed synergistic effects in keratinocyte migration, restoration of FGF-7 levels, and anti-inflammatory action, leading to accelerated wound healing mediated by negative regulation of miR-155, using an in vitro co-culture model and in vivo mouse model of the diabetic wound. Furthermore, treatment with miR-155-inhibitor-loaded MSC-derived exosomes led to enhanced collagen deposition, angiogenesis, and re-epithelialization in diabetic wounds. This study revealed the therapeutic potential of miR-155-inhibitor-loaded MSC-derived exosomes in diabetic wound healing and opened the doors for encapsulating miRNAs along with antibiotics within the MSC-derived exosomes toward improved management of chronic, nonhealing diabetic wounds.

Peptide-Chitosan Engineered Scaffolds for Biomedical Applications.

Peptides are signaling epitopes that control many vital biological events. Increased specificity, synthetic feasibility with concomitant lack of toxicity, and immunogenicity make this emerging class of biomolecules suitable for different applications including therapeutics, diagnostics, and biomedical engineering. Further, chitosan, a naturally occurring linear polymer composed of d-glucosamine and N-acetyl-d-glucosamine units, possesses anti-microbial, muco-adhesive, and hemostatic properties along with excellent biocompatibility. As a result, chitosan finds application in drug/gene delivery, tissue engineering, and bioimaging. Despite these applications, chitosan demonstrates limited cell adhesion and lacks biosignaling. Therefore, peptide-chitosan hybrids have emerged as a new class of biomaterial with improved biosignaling properties and cell adhesion properties. As a result, recent studies encompass increased application of peptide-chitosan hybrids as composites or conjugates in drug delivery, cell therapy, and tissue engineering and as anti-microbial material. This review discusses the recent investigations involving chitosan-peptide materials and uncovers various aspects of these interesting hybrid materials for biomedical applications.

MiR-155 Inhibitor-Laden Exosomes Reverse Resistance to Cisplatin in a 3D Tumor Spheroid and Xenograft Model of Oral Cancer.

Cisplatin resistance is one of the major concerns in the treatment of oral squamous cell carcinoma (OSCC). Accumulating evidence suggests microRNA (miRNA) dysregulation as one of the mediators of chemoresistance. Toward this, our previous study revealed the role of exosomal microRNA-155 (miR-155) in cisplatin resistance via downregulation of FOXO3a, a direct target of miR-155, and induction of epithelial-to-mesenchymal transition in OSCC. In the present study, we demonstrate the therapeutic potential of miR-155 inhibitor-laden exosomes in the sensitization of a cisplatin-resistant (cisRes) OSCC 3D tumor spheroid and xenograft mouse model. The cisRes OSSC 3D tumor spheroid model recapitulated the hallmarks of solid tumors such as enhanced hypoxia, reactive oxygen species, and secretory vascular endothelial growth factor. Further treatment with miR-155 inhibitor-loaded exosomes showed the upregulation of FOXO3a and induction of the mesenchymal-to-epithelial transition with improved sensitization to cisplatin in cisRes tumor spheroids and xenograft mouse model. Moreover, the exosomal miR-155 inhibitor suppressed the stem-cell-like property as well as drug efflux transporter protein expression in cisplatin-resistant tumors. Taken together, our findings, for the first time, established that the miR-155 inhibitor-loaded exosomes reverse chemoresistance in oral cancer, thereby providing an alternative therapeutic strategy for the management of refractory oral cancer patients.

Biotin-Avidin-Mediated Capture of Microspheres on Polymer Fibers.

Systems for efficient and selective capture of micro-scale objects and structures have application in many areas and are of particular relevance for selective isolation of mammalian cells. Systems for the latter should also not interfere with the biology of the cells. This study demonstrates the capture of microspheres through orthogonal coupling using biotin (ligand) and (strept)avidin (receptor). Fibrous poly(ethylene terephthalate) (PET) meshes were hydrolyzed under controlled alkaline conditions to obtain activated surfaces with COOH groups allowing for the functionalization of the PET with biotin of various spacer length. The system capture efficiency was optimized by varying the length of spacer presenting the biotin against streptavidin. In a proof of concept experiment, avidin-functionalized microspheres were used as surrogates for cells, and their capture under dynamic conditions including virous mixing and high-flow rate perfusion is demonstrated. Functionalization of PET meshes with biotin conjugated to longest spacer yielded the most efficient capture of microspheres. These preliminary results lay the foundation for the development of biosystems for capture of specific cells under physiologically relevant conditions, using biorthogonal avidin-biotin interactions.

Recapitulating epithelial tumor microenvironment in vitro using three dimensional tri-culture of human epithelial, endothelial, and mesenchymal cells.

BACKGROUND: Three-dimensional (3-D) cultures of cancer cells can potentially bridge the gap between 2-D drug screening and in vivo xenografts. The objective of this study was to characterize the cellular and extracellular matrix characteristics of spheroids composed of human lung epithelial cells (epi), pulmonary vascular endothelial (endo) cells, and human marrow-derived mesenchymal stems cells (MSCs). METHODS: Spheroids composed of epi/endo/MSCs, termed herein as synthetic tumor microenvironment mimics (STEMs), were prepared by the hanging drop method. Cellular composition and distribution in the STEMs was characterized using fluorescence microscopy. Induction of reactive oxygen species and upregulation of efflux transporters was quantified using fluorometry and PCR, respectively, and phenotypic markers were qualitatively assessed using immunohistochemistry. RESULTS: STEMs exhibited three unique characteristics not captured in other spheroid cultures namely, the presence of a spheroid core devoid of epithelial cells and primarily composed of MSCs, a small viable population of endothelial cells hypothesized to be closely associated with MSCs within the hypoxic core, and discrete regions with high expression for vimentin and cytokeratin-18, whose co-expression is co-related with enhanced metastasis. Although cells within STEMs show elevated levels of reactive oxygen species and mRNA for ABC-B1, an efflux transporter associated with drug resistance, they exhibited only modest resistance to paclitaxel and gemcitabine in comparison to 2-D tri-cultures. CONCLUSIONS: The epi/endo/MSC spheroid model described herein offers a promising platform for understanding tumor biology and drug testing in vitro.

Nonwoven Carboxylated Agarose-Based Fiber Meshes with Antimicrobial Properties.

Hydrogel forming polysaccharides, such as the seaweed derived agarose, are well suited for wound dressing applications as they have excellent cell and soft tissue compatibility. For wound dressings, fibrous structure is desirable as the high surface area can favor adsorption of wound exudate and promote drug delivery. Although electrospinning offers a straightforward means to produce nonwoven fibrous polymeric structures, processing agarose and its derivatives into fibers through electrospinning is challenging as it has limited solubility in solvents other than water. In this study we describe the processing of carboxylated agarose (CA) fibers with antibacterial properties by electrospinning from a solution of the ionic liquid (IL) 1-butyl-3-methylimidazolium chloride ([Bmim]+Cl-) possessing antimicrobial properties. The extent of carboxylation was found to impact fiber diameter, mesh elastic modulus, fiber swelling, and the loading and release of IL. IL-bearing CA fibers inhibited the growth of Staphylococcus aureus and Pseudomonas aeruginosa, bacteria commonly found in wound exudate. In sum, nonwoven CA fibers processed from IL are promising as biomaterials for wound dressing applications.

Graded Mobilization With Pacing Technique for Functional Mobility in a Preoperative Marfan Syndrome Case of Aortic Root Dilation: A Case Report.

Marfan syndrome (MFS) presents complex cardiovascular manifestations and challenges in management due to its impact on multiple body systems. This case study examines the clinical profile, diagnostic findings, and physiotherapy intervention for a 57-year-old male with MFS who experienced severe aortic and mitral valvular complications. The patient's admission was marked by fatigue, reduced mobility, breathlessness, and a confirmed diagnosis of MFS. Cardiac evaluation revealed severe regurgitation and aortic root dilation. The patient's symptoms were exhaustion, giddiness, dyspnea, and decreased mobility. The objective of this case study was to describe the impact of graded mobilization and pacing techniques in maximizing functional mobility and alleviating symptoms associated with aortic regurgitation and aortic root dilatation through an extensive physiotherapy program. Exercises addressing dyspnea, lung capacity, posture, functional mobility, and fatigue reduction were included in the physiotherapy intervention. The rehabilitation outcome showed a notable shift of score from 3 to 0.5 on the Borg scale of dyspnea, indicating enhanced functional capacity and improved quality of life. Post-rehabilitation, the patient exhibited significant progress in the two-minute walk test. This case highlights the importance of tailored interventions in managing MFS-related cardiac complications.

Integrating Physiotherapy for Enhancing Functional Recovery in Glioblastoma Multiforme: A Case Report.

Glioblastoma is the most prevalent primary brain tumor. Because glioblastomas are very vascular, they may worsen the disease's neurologic symptoms by causing vasogenic brain edema and mass effects with a wide range of other symptoms. In this case report, a 42-year-old male complaining of severe headache, generalized weakness, and forgetfulness was brought to a territory care hospital, where a detailed neurological examination and investigations with magnetic resonance imaging (MRI) revealed a grade IV (high-grade) glioma at the right frontotemporal and capsuloganglionic regions of the brain, and was suggested for surgery. Postoperatively, the patient was referred for chemotherapy, but due to severe weakness, fatigue, and motor deficits, he was referred for physiotherapy. Follow-up was conducted to monitor the patient's progression using various outcome measures. These measures included the Functional Independence Measure (FIM), the Intensive Care Unit (ICU) Mobility Scale, the Glasgow Coma Scale (GCS), the modified Rankin Scale (mRS), and the Karnofsky Performance Status (KPS) Scale. Significant improvement was observed in the patient's symptoms, as tracked by these outcome measures. Therefore, it is important that a tailored rehabilitation protocol of six weeks was planned, focusing on palliative care and some symptoms of weakness, reduced strength, tone, and breathlessness to prevent secondary complications like deep vein thrombosis, irritability, anxiety, forgetfulness, decreased balance, and coordination in sitting. Since the prognosis of grade IV glioblastoma is poor, the goal-oriented rehabilitation program will help improve the palliative status and the overall quality of life of the patient.

Exploring the Efficacy of Physiotherapy in Guillain-Barré Syndrome Through Virtual Reality-Based Rehabilitation: A Case Report.

Guillain-Barré syndrome (GBS) refers to a spectrum of acute immune-mediated polyradiculoneuropathies, among which is acute motor axonal neuropathy (AMAN), which is typified by predominant motor involvement and axonal degeneration. This case study describes the presentation, diagnosis, and physiotherapy management using virtual reality-based technology in a 29-year-old male patient with AMAN. Nerve conduction velocity testing was used to diagnose motor axonal neuropathy in the patient, who had weakness subsequent to gastrointestinal symptoms. Intravenous immunoglobulin therapy was started, and a physiotherapy protocol was planned for eight weeks according to the patient's functional status. Physiotherapy plays an important role in the rehabilitation of patients with GBS, addressing the specific motor deficits and promoting recovery. The aim was to improve muscle strength, mobility, and functional independence through progressive exercises targeting specific motor deficits. Virtual reality-based training was also part of this rehabilitation process as an adjunct to conventional rehabilitation to improve dynamic balance and function of the upper and lower limbs, which showed significant improvement in the outcome measures.

Physiotherapy Rehabilitation for Above-Knee Amputation Secondary to Infected External Fixation: A Case Report.

This case study examines the total physiotherapy care of a 50-year-old male patient, who had a right-sided displaced distal tibia and fibula fracture, a talus fracture due to a road traffic accident, and an above-knee amputation due to a serious infection. Enhancing muscle strength, reducing pain from phantom limbs, avoiding problems, maintaining range of motion, increasing endurance, and promoting functional independence in the postoperative period were the main goals of the patient's rehabilitation. The recovery plan included an intensive four-week program of physiotherapy care. The regimen included a variety of interventions, such as pain management, edema control, wound healing techniques, range of motion (ROM) exercises, muscle strengthening activities, mobility and transfer exercises, cardiovascular endurance training, psychosocial support, education on prosthetic use, and independence in daily living activities. ROM measures, manual muscle testing, and functional independence measure scores were used to evaluate the patient's improvement. The patient's physical health and level of functional independence both exhibited significant improvements, according to the statistics. Following treatment, the patient's ROM, muscle strength, and overall functional independence all improved. The study highlights the positive impacts of physical therapy interventions on the patient's quality of life, mobility, and self-sufficiency following the amputation and subsequent recovery. These findings support the patient's transition to a more self-sufficient and active lifestyle by providing valuable insights into the efficient use of physiotherapy and the comprehensive post-amputation treatment plan.

The Role of Early Rehabilitation in Better Outcomes in a Rare Presentation of Tuberculous Meningitis With Broca's Aphasia.

There is a complex link between tuberculous meningitis (TBM) and aphasia, in which a language impairment is caused by an injury to the cortical language centre. The parts of the brain that function for speech and language production are the Wernicke's, Broca's, and arcuate fasciculus regions. This case report mainly highlights the neurological consequences of TBM, and how it affects language and speech functioning. It outlines a comprehensive physiotherapy rehabilitation program that targets a range of issues for the patient, such as verbal output, weakness, motor deficits, articulation issues in speech, and coordination issues. Various treatment modalities can help correct weakness, improve balance and coordination, increase flexibility and range of motion (ROM), and make speech more fluent. The case report emphasizes the necessity of using an integrated approach that combines speech-language therapy (SLT), melodic intonation therapy (MIT), constraint-induced aphasia therapy (CIAT), medication treatments, and physical therapy to address the multifaceted impacts of TBM-induced aphasia on a patient's quality of life (QOL).

Rehabilitation Strategies for Wernicke-Korsakoff Syndrome: Physiotherapy Interventions and Management Approaches.

Korsakoff syndrome and Wernicke's encephalopathy (WE) show neurological and cognitive deficits. Wernicke-Korsakoff syndrome (WKS) is a compound neurological condition. The cause of this neurological condition could be the consumption of alcohol regularly for a chronic duration. A tailored rehabilitation protocol that focuses on cognitive and physical deficiencies was implemented along with thiamine supplementation for managing a case of a 49-year-old male patient who had a history of high alcohol consumption and was exhibiting typical signs of WKS. After planning a proper physiotherapy plan, it is necessary to look after the patient's progress along with re-evaluation, which reveals notable gains in cognitive function, memory, and functional independence. There is a dearth of research on the impact of physical therapy in managing WKS. The above case report reflects the benefits of combining physiotherapy, cognitive rehabilitation, and balance training to improve patient functionality and independence. Tailored rehabilitation interventions like the Benson relaxation method (BRM), brain gym exercises, Frenkel's exercise, electrical stimulation, sensorimotor training, basic body awareness therapy (BBAT), and gait training can be used to enhance a patient's quality of life. Addressing individual needs is essential in managing WKS, focusing on the importance of comprehensive care beyond cognitive rehabilitation alone.

A Tailored Physiotherapy Program in a Rare Case of Bilateral Territorial Cerebral Artery Infarction With Systemic Lupus Nephritis: A Case Report.

A stroke is a medical emergency that requires rapid treatment. Early intervention can help prevent brain damage and other negative consequences. An ischemic stroke occurs when a blood clot blocks or narrows a blood artery leading to the brain. Systemic lupus erythematosus (SLE) is characterized by systemic inflammation, autoantibodies, and a relapsing-remitting illness. Patients with SLE have an increased cumulative risk of cardiovascular events, including stroke, especially in the first five years after diagnosis. This case study presents the comprehensive physical therapy treatment of a 52-year-old woman diagnosed with systemic lupus nephritis and bilateral area infarct, an unusual combination. This condition resulted in issues such as decreased mobility, muscle weakness, and cognitive impairments. The specialized physiotherapy program employed a diverse strategy to address neurological weaknesses with multimodal stimulation, range of motion exercises, strength training, balance training, and more. The approach also includes energy-saving techniques and adaptive ways to manage symptoms associated with lupus nephritis to address fatigue and joint stiffness. The positive outcomes highlight the importance of tailored physical therapy regimens in maximizing functional recovery and improving the quality of life in the challenging context of concurrent bilateral infarct and systemic lupus nephritis. This case study emphasizes the need for individualized rehabilitation strategies in enhancing overall patient outcomes, contributing valuable insights to the sparse literature on managing such complex cases.

Targeted Physiotherapy for an Interesting Case of Spontaneously Resolving Extracapsular Infarct: A Case Report.

Stroke is a prevalent and disabling illness that is becoming more common in developing countries. After a stroke, physical inactivity frequently results in long-term deconditioning and disappointing consequences. This case study focuses on an infrequent 0.3% of ischemic stroke cases that occur in the external capsular (ECC) or extreme capsular (EXC) region. In sub-insular infarcts, ECC-EXC lesions are distinct and frequently linked to the anterior opercular syndrome. We are presenting the case of an 86-year-old female patient who had a fall and loss of consciousness. Diagnostic tests revealed that the patient had an extracapsular ischemic event; due to unstable vital signs and frequent drop in saturation of peripheral oxygen (SpO2) levels, the patient was intubated and admitted to the intensive care unit (ICU). When stable, the patient experienced generalized weakness, for which she was referred for physical therapy. Balance and gait impairments were secondary to weakness. A planned two-week structured physiotherapy intervention was created with an emphasis on gait training, muscle strengthening, and balance. Adaptive gait training, progressive exercises, and balancing activities addressed the patient's limitations. This case study demonstrates how an elderly individual with an external capsule ischemic event can benefit from targeted physical therapy for increasing muscle strength, balance, and gait performance. Positive results emphasize how crucial early and targeted physiotherapy is for supporting stroke survivors' neurological recovery.

Physiotherapy Strategies in Hypokalemic Periodic Paralysis: A Case Report.

The rare neuromuscular disease known as hypokalemic periodic paralysis (hypoKPP), which results in severe muscle weakness in the extremities, is brought on by abnormalities in potassium transport within cells. Laboratory testing is confirmatory, which reveals notably low potassium levels, causing paralysis, which improves once the low potassium is restored. The patient generally complains of muscle weakness with difficulty in performing activities of daily living and impaired participation in functional tasks, with few suffering from coexisting sensory impairments. Physiotherapy generally plays a symptomatic role with motion exercises for the affected muscle groups. There is no standardized physiotherapy protocol for disease-specific impairments. A 46-year-old man complained of bilateral upper and lower limb muscular weakness and was admitted to the neurology ward. The patient also complained of having tingling numbness throughout their entire limbs and had experienced similar episodes of symptoms six months prior. During laboratory evaluation, a significantly low potassium level was found, leading to a diagnosis of hypoKPP. Following medical management, neurophysiotherapy was initiated. Physiotherapy strategy shows significant improvement in muscular strength and functional activities. Thus, this case report concludes that physiotherapy plays a vital role in managing hypoKPP by enhancing muscular strength, functional activities, and quality of life.

From Trauma to Recovery: A Comprehensive Management of Achilles Tendon Injury in a Young Female.

The incidence of the Achilles tendon getting injured has recently increased by 18 in 100,000. Compared to non-surgical treatment, surgical results are superior. The Achilles tendon repaired with surgery has a re-rupture rate of only 5%, while if treated non-operatively, it has a rupture rate of 40%. This case report analyses the traumatic Achilles tendon rupture and subsequent surgical repair in a young woman. In this case study, a 19-year-old female patient's severe Achilles tendon injury was successfully managed by integrating prompt surgical intervention and structure. After rehabilitation, the patient's range of motion (ROM), muscle strength, and gait patterns all significantly improved. Scores on the Lower Extremity Functional Scale (LEFS) and the Dynamic Gait Index (DGI) both significantly improved. This case study reiterates the significance of an integrated healthcare strategy for Achilles tendon injuries. An immediate surgical procedure followed by a specific rehabilitation programme accelerates healing and the return to optimal function. The results emphasize the critical role of physical therapy in assisting surgical interventions and underline the necessity of comprehensive patient care in the treatment of complex orthopaedic problems.

Comprehensive Rehabilitation of a Patient With Foot Drop Secondary to Lumbar Canal Stenosis: A Case Report.

One of the most prevalent degenerative musculoskeletal conditions is lumbar spinal canal stenosis (LSS), which is characterized by narrowing of the lumbar spinal canal that pressures the nerve roots and cauda equine. LSS, when treated surgically, usually presents with foot drop as its major complication. Foot drop is a common presentation of several clinical diseases, traditionally characterized as severe weakening of ankle and toe dorsiflexion. Foot drop has a great impact on patients' lives, lowering their quality of life and affecting their activities of daily living. Ankle dorsiflexion weakness leads to foot drop and a high-stepping gait, which can cause multiple falls and accidents. This case study aimed to assess the efficacy of a customized physiotherapy program in a 50-year-old woman with paraparesis along with left foot drop and post-surgery complications following lumbar decompression and spinal fusion at L3-S1 (lumbar-sacral) level after a jerk experienced by her while working out in the gym. The objective was to determine the impact of individualized exercises on the patient's strength, gait, balance, and pelvic floor function over a 12-week rehabilitation period. The interventions included lower limb exercises (stretching exercises, strengthening exercises, and weight-bearing exercises), pelvic floor exercises, and core stability training. The findings demonstrated significant improvements in the patient's functional outcomes, as evidenced by enhanced scores in the Berg Balance Scale, Manual Muscle Testing, Dynamic Gait Index, Barthel Index, and Stanmore Assessment Questionnaire. Notable progress was observed in the strength, balance, gait, and pelvic floor function, highlighting the positive influence of targeted physiotherapeutic interventions. This case underscores the importance of tailored exercise plans in addressing the complexities of post-surgery challenges, emphasizing the potential for comprehensive recovery and improved overall quality of life through personalized physiotherapy.