505 - Finding Balance: Management of Segmental Dystonia in Acute Inpatient Rehabilitation

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

RV

Ronak N. Venkata, BS

Medical Student
University of Miami Miller School of Medicine
Miami, Florida, United States

Co-Author(s)

GA

Gemayaret Alvarez, MD

Associate Professor
University of Miami
Miami, Florida, United States
JP

Jonathan Paul, MD

Resident Physician
University of Miami / Jackson Memorial Hospital
Miami, Florida, United States

Submitter(s)

RV

Ronak N. Venkata, BS

University of Miami Miller School of Medicine
Miami, Florida, United States

Case Diagnosis: 56-year-old female with history of cavernous malformation admitted to acute inpatient rehab after cavernoma resection complicated by new onset segmental dystonia.

Case Description: 56-year-old female with recent diagnosis of large, cavernous malformation, associated with worsening headaches and ataxic gait, presented to acute inpatient rehabilitation status post suboccipital cavernoma resection. On arrival she demonstrated right oculomotor nerve palsy, bilateral upper extremity ataxia, and dystonic movements in the right sternocleidomastoid with head titubation. Therapies were limited due to excessive movement, poor coordination, and low endurance. She required total assist on therapy evaluation. She was diagnosed with Meige syndrome and started on trihexyphenidyl, clonazepam, and baclofen. Despite pharmacologic efforts, therapies remained limited. She was then trialed with a weighted vest, weighted utensils, and prolonged expiration to increase vagal tone. At discharge, she required moderate-assist with transfers and ambulation with a rolling walker while wearing the vest, and minimum-assist with eating and oral hygiene using weighted hand grips. 

Discussions: When segmental dystonia responds poorly to medication, alternative approaches can maximize time in acute rehabilitation. Weighted vests provide proprioceptive input, improve postural stability and motor coordination by enhancing central nervous system awareness, which can help reduce involuntary movements. Weighted utensils assist fine motor control by adding resistance, decreasing tremor amplitude during functional tasks. Additionally, prolonged expiration techniques may increase vagal tone, reduce sympathetic activity, and improve motor control. These strategies, when integrated into a comprehensive therapeutic plan, offer valuable alternatives for managing symptoms and improving functional outcomes in patients with treatment-resistant movement disorders. 

Conclusions: Segmental dystonia can severely limit function. A multimodal and patient-centered approach utilizing adjunctive strategies such as weighted vests, utensils, and prolonged expiration is necessary to optimize mobility and improve independence when pharmacologic treatment fails. 