Parkinsonism following head injury: rehabilitation outcome with and without pharmacological treatment

Abstract

Parkinsonism following head injury is a rare occurrence. This study describes the rehabilitation outcome in a 16-year-old male with hemiplegia and parkinsonism resulting from head injury. A trial using repeated treatment design with six phases was established to measure the effect of rehabilitation with and without treatment using Sinemet (carbidopa/levodopa). Measurements of functional changes in mobility and activities of daily living, speech production, swallowing and hand dexterity were carried out using the modified Barthel Index, dysarthria severity rating scale, dysphagia severity rating scale and nine-hole peg test respectively. There was significant improvement in function including return of speech production while on Sinemet, but this attained function was completely lost upon withdrawal of Sinemet. Resumption of treatment with Sinemet resulted in improved level of function. At the completion of rehabilitation the modified Barthel Index score was 100/100, swallowing was normal, there was mild dysarthria and the patient required only 33 seconds to complete a nine-hole peg test- he remains functionally independent eight years later. Pharmacological management, in conjunction with rehabilitation, effectively improved functional outcome.

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