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This is a case report of Mr S, a 43-year-old man with a spinal cord lesion caused by tuberculosis resulting in incomplete paraplegia. He was discharged from hospital with significant residual disability. He received a major part of his rehabilitation in the community from an interdisciplinary neuro rehabilitation team with good results. Because Mr S was overweight, over 20 stones, the therapists had to use considerable creativity and imagination to facilitate his rehabilitation. Mr S's high level of motivation and courage was essential to the success achieved. The purpose of the case report is to demonstrate that a positive outcome can be achieved despite the many difficulties faced in the rehabilitation of an overweight patient with an incomplete spinal cord lesion in a community setting.