504 - Parkinson’s at 15: Rehabilitation for a Rare Traumatic Case of Dystonia

Case Diagnosis: A 15-year-old male was diagnosed with early-onset Parkinson’s disease (PD) after a traumatic event in which someone grabbed his neck and threw him onto concrete. Now 25, he presented with progressive right upper extremity (RUE) dystonia. He reported stiffness and difficulty with activities of daily living (ADLs), limiting self-care and job duties in a hospital mailroom. Treatment included occupational therapy (OT) twice weekly, a weighted hand brace, and Botox injections every three months.
 

Case Description: Exam revealed increased flexor tone, ulnar deviation, and thumb adduction, with grip strength 4/5 right and 5/5 left. A palpable nodule at the left second MCP raised concern for trigger finger. Gait analysis noted reduced arm swing bilaterally without assistive device use. Botox injection targeted forearm flexors with improvement in supination and digit extension. 
 

Discussions: A significant traumatic brain injury (TBI) can directly injure the substantia nigra pars compacta (SNpc), where dopamine-producing neurons live. Trauma can also disrupt protein clearance systems such as autophagy and ubiquitin-proteasome pathway. Misfolded proteins like α-synuclein begin to accumulate and form toxic aggregates (Lewy bodies), which are the pathological hallmark of PD. PD typically presents in older adults with tremor, rigidity, and bradykinesia, whereas juvenile-onset cases are rare and more complex. This patient’s dystonia, spastic wrist and hand posturing, trigger finger, delayed speech, and drooling highlight atypical features uncommon in elderly-onset Parkinson’s. His regimen includes carbidopa-levodopa, amantadine, and trihexyphenidyl, underscoring the need for multimodal management. These symptoms create distinct rehabilitation challenges, including fine motor impairment, contracture risk, and vocational limitations. Management must extend beyond medication to include tone reduction, bracing, and therapy to preserve independence.
 

Conclusions: Individualized OT emphasizes AROM, PROM, and task-specific training. Weighted bracing optimizes positioning and contracture prevention, while adaptive tools and motor strategies may improve job performance and participation in daily tasks.