Successful treatment of post-concussion headaches and related symptoms in a 16-year-old soccer player using neurorehabilitation strategies
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1
Life University, United States
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2
Southwest Brain Performance Center (SBPC), United States
Presentation:
A 16-year-old male presented to a chiropractic functional neurology clinic with a chief complaint of persistent post-concussion headaches and related symptoms, such as sensitivity to light, loud sounds, dizziness, and imbalance, from a soccer accident he endured four months prior. These symptoms were severe enough to interfere with his ability to exercise, practice and play soccer. The patient claimed that since the accident he experienced car sickness and riding downwards in an elevator created a sense of “free-falling” discomfort. The patient was being seen concurrently for anxiety/depression by his primary care physician (PCP) and was taking his prescribed Prozac.
Findings:
The patient underwent a complete neurological examination which revealed abnormal ocular neurological findings such as left hypertropia, right ptosis, right convergence spasm, multidirectional diplopia on gaze fixation, saccadic intrusions on pursuits and optokinetic stimulation, 50% failure in horizontal and 80% failure in vertical anti-saccades, and diplopia on right and left gaze fixation. Additional examination findings included decreased right soft palate elevation on vocalization with minimal gag reflex, finger tapping and arm swing on gait graded 2 on the right for decreased amplitude, gait with dual tasking graded 1 for decreased amplitude on right, finger to nose testing was hypermetric bilaterally, a 3-4 beat clonus on right ankle clonus testing and an up-going extensor toe on right plantar reflex testing, and Achilles reflex testing was graded 3+ bilaterally. Dix-Hallpike testing was positive for right posterior canal activation. The Rivermead Post-Concussive Symptoms Questionnaire (RPSQ) was scored a 39 out of 64 and the Subjective Units of Distress Scale (SUDS) was graded a 30 out of 100. C3 LogixTM Graded Symptoms of Concussion Questionnaire had a symptom count of 23 out of 27 and a symptom severity score of 82 out of 162. Computerized Assessment of Postural Systems (CAPS) testing showed mild to moderate instability on all tests utilizing a perturbed surface.
Methods:
A multi-modal neurorehabilitation program was administered 3 times a day over a 5-day period. Sessions included spinal manipulation therapies, vestibular stimulation, cranial nerve stimulation, head-eye motion therapies, cerebellar exercises, neurosensory integration, Brock beads/string exercises, cranial nerve neuromodulation, Stroop effort exercises, and low-level laser therapy. These treatments were monitored and modulated at each session according to patient results.
Outcome:
At the conclusion of the 5-day treatment period, the patient was free of headaches and could exercise and play soccer. He stated that he felt “80% better”. The patient’s mother reported that he was “happier” and with the approval of his PCP, he stopped taking Prozac. The patient was able to return to his athletic activities with 100% full effort within 3 weeks of his treatment. Clonus and up-going toe on testing was resolved. Dix-Hallpike test was negative for all canals. The RPSQ decreased to a 21 out of 64 and the SUDS decreased to a 10 out of 100. C3 Logix Graded Symptoms of Concussion Questionnaire decreased to a symptom count of 19/27 and symptom severity of 36/162. Computerized Assessment of Postural Systems (CAPS) testing showed improved stability on every one of the perturbed tests.
Conclusion:
The authors suggest further investigation into the improved neurological function and resolution of post-concussion syndrome symptoms by this type of multi-modal neurorehabilitation approach, due to the success shown in this patient case.
Keywords:
Concussion and sports,
concussion,
Neurorehabilitation after Brain Injury,
post-concussion headaches,
chiropractic neurology
Conference:
International Symposium on Clinical Neuroscience, Orlando, United States, 24 May - 26 May, 2019.
Presentation Type:
Poster Presentation
Topic:
Clinical Neuroscience
Citation:
Esposito
SE,
Steward
J and
Pendleton
M
(2019). Successful treatment of post-concussion headaches and related symptoms in a 16-year-old soccer player using neurorehabilitation strategies.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience.
doi: 10.3389/conf.fneur.2019.62.00004
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Received:
01 Apr 2019;
Published Online:
27 Sep 2019.
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Correspondence:
Mx. Susan E Esposito, Life University, Marietta, United States, susanesposito@gmail.com