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Neurological Rehabilitation

Management of Hemiballismus in the Acute Inpatient Rehabilitation Setting : A Case Presentation

Thursday, October 23, 2025
12:45 PM - 2:15 PM MT
Location: Kiosk 5

    Poster Presenter(s)

  • Lea Jarrett, MD (she/her/hers)

    Resident Physician
    Medical College of Wisconsin Affiliated Hospitals PM&R Program
    Milwaukee, Wisconsin

    • Co-Author(s)

  • JC

    Jeffrey Cheng, MD

    Assistant Professor
    Medical College of Wisconsin
    Brookfield, Wisconsin

  • CM

    Clara Martin, MPH

    Medical Student
    Medical College of Wisconsin Affiliated Hospitals PM&R Program
    Milwaukee, Wisconsin

Disclosure(s):
Lea Jarrett, MD: No financial relationships to disclose
Case Diagnosis: A 65-year-old male with a history of cocaine use, uncontrolled hypertension, heart failure, and obstructive sleep apnea presented with left sided hemiballismus in the setting of a subacute, right thalamic hemorrhagic stroke.

Case Description or Program Description: Exam was notable for hyperkinetic involuntary writhing movements of the left arm and leg exacerbated by finger-to-nose and heel-to-shin testing along with mildly decreased proximal strength of the left upper extremity and preserved lower extremity strength. He was modified independent with bed mobility and sit-to-stand transfers, and contact-guard-assist for ambulation with a four-wheeled walker. He was independent with eating, and set up assist for oral hygiene and bathing, upper/lower body dressing. Stairs and toilet transfers were not assessed due to safety concerns. He was started on risperidone and ultimately transferred to the acute inpatient rehabilitation unit. His hospital stay was complicated by symptomatic hypotension requiring titration of risperidone, anti-hypertensive agents, and heart failure medications.

Setting: Acute inpatient rehabilitation hospital

Assessment/Results: Following a three-week course of inpatient rehabilitation and treatment with low-dose risperidone, the patient demonstrated significant functional improvement. He was modified independent with bed mobility, sit-to-stand transfers, ambulation with a four-wheeled walker, and stairs. His Berg Balance Scale improved from 30 to 44. His six-minute-walk test improved from 604 to 1111 feet. His self-selected gait speed increased from 0.5 to 1.0 meters per second. He was independent with eating, oral hygiene, bathing, upper/lower body dressing, and toilet transfers. His hemiballismus also significantly reduced in amplitude and frequency.

Discussion (relevance): To our knowledge, this is the first reported case of hemiballismus managed with a combination of low-dose risperidone and acute inpatient rehabilitation.

Conclusions: Hemiballismus is a rare post-stroke condition that can be effectively managed in the acute rehabilitation setting. This case demonstrates that managing hemiballismus with low-dose risperidone and inpatient rehabilitation may improve functional outcomes.