Disclosures: Jason M. Andrade, DO, MSMHS: No financial relationships or conflicts of interest

Case Description: Patient presented to Emergency Department after having bilateral jaw dislocation from acute dystonia from uncontrolled Atypical Parkinson’s Disease (PD). PD medications were increased and adjusted with plan of transitioning to continuous Carbidopa-Levodopa infusion in the near future. Jaw was relocated by Oral and Maxillofacial Surgery. Gastric-tube (G-tube) was placed and patient was initiated on 5-hour nocturnal feeding to limit interaction with medication absorption and feeding. Hospital course was complicated by Urinary Tract Infection (UTI) and Clostridium Difficile (C.Diff) infections. Patient also had new right ankle contracture. Transferred to Acute Rehabiliation Hospital (ARH) for functional upgrading.

Setting: Acute Rehabilitation Hospital (ARH)

Patient: 71-year-old male with history of anxiety, Transient Ischemic Attack, and PD who presents to ARH after bilateral jaw dislocations and impaired mobility from acute dystonia from Atypical PD. Assessment/

Results: Upon Admission to ARH, patient had severe dysphagia. He required Total Assistance for G-tube feeding and bladder supra-pubic catheter management. He required Total Assistance for mobility due to poor balance, retropulsion, right ankle contracture, and severely slow initiation. Patient participated with therapy and received equipment from Orthotics over a 4-week course of Acute Rehabilitation. He was upgraded to Minimal/Moderate Assistance with most Physical Therapy and Occupational Therapy parameters. Chin bracing was removed and patient improved to therapeutic feeds with Speech Therapy. Patient was discharged to Skilled Nursing Facility until family could arrange proper assistance at home.

Discussion: Unlike PD, Atypical PD is less understood and more difficult to manage. Atypical PD is defined as Parkinson’s-like features that are unresponsive to Levodopa. Stabilization with medical management can take months to years. Early therapy in Acute Rehabilitation can decrease functional decline and provide equipment that can help the patient manage at home during this time.

Conclusion: ARH is a necessity of treatment for functional improvement in Atypical PD while they trial various forms of medical management.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/acute-dystonia-with-bilateral-jaw-dislocation-from-atypical-parkinsons-disease-a-case-report/