Neurological rehabilitation of a patient with unrelenting head pain associated with post-concussive syndrome
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1
Georgia Chiropractic Neurology Center, United States
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2
Life University, United States
Background:
A twelve-year-old male patient presented to a chiropractic neurology center following his third traumatic head injury. The patient’s chief complaint was constant head pain rated at a 7/10. It would reach 10/10 and only dropped to 4/10 one time in the month between the incident and the first office visit. He reported unrelenting dull, aching, and sharp pain located in the head, the dull aching pain was “all over” and the intermittent sharp pain was primarily on the sides of his head- above his ear in the temple region. Triggers such as sneezing, loud noises, and looking at screens such as television or a computer, brought on the sharp pain. The patient also complained of sensitivity to light and sound, stomach pains, vertigo, and blurry vision that made reading very difficult. The patient experienced sporadic flashes of bright white lights in his visual field. The bright lights would also induce diplopia. The patient further described this experience as seeing many lights appear around one light source. The first incident occurred when the patient fainted at his school desk, hit his head and fell out of the chair hitting his head on the floor and becoming unconscious. The second incident occurred when he had knocked himself out on the playground previously by falling and hitting his head. The third incident that brought him into the office occurred more recently when he hit his anterior right portion of his head on concrete.
Methods:
The patient became nauseous during Videonystagmography (VNG) testing. This is a method of graphing out the speed and accuracy of a multitude of eye movements including but not limited to saccades, pursuits, and optokinetic reflexes. He reported the sensation of the world spinning to the right and thought he was falling to the right. Patient had an aversive response to light during pupillary light response testing. During nystagmus testing, the patient had upward and rightward drifting of the eyes as well as convergence. During leftward gaze testing, the patient had vertical oscillations and right gaze testing exposed torsional and horizontal oscillations. Bilateral spinal perez testing was positive, along with percussive myotonia, occurring when a reflex hammer was struck on the thenar region of his thumb causing clonus. Piano playing testing, where the patient attempted to wiggle his fingers in a rapid alternating pattern, was slower on the left side as was the finger to thumb tapping test, and alternating supination and pronation of the upper extremity. The patient laterally flexed during gait bilaterally, alternating with each step, which improved with dual tasking (having the patient verbalize every other month of the year while walking), however with dual tasking the patient developed a shuffling gait and experienced freezes, where he would stop all movement. When cervical compression was performed, the patient developed pain over his entire head that was described as higher than 10/10. Trigger points were apparent in the left sub-occipital muscles and left scalene muscles which referred pain into the head over the temporal and frontal regions. During computerized analysis of postural systems (CAPS), which measures stability, the patient scored in the 70’s, out of a possible score of 100, standing on a perturbed (foam cushion) surface. Spinal vertebral movement restrictions were detected at the second and fifth cervical levels. Treatment consisted of complex movements of the limbs where the patient would be guided to use his arms and legs to draw different geometric shapes; saccadic and anti-saccadic eye movements, which involved having the patient look quickly to a moving target or look quickly to a non-moving target; sound mapping, where the patient was required to close his eyes and point to a area where he perceived an auditory stimulus (snapping of the fingers) originated; gaze stabilization exercises, where the patient would visually fixate on a target and would have his head passively rotated in a certain pattern; myofacial release therapy involving various manual and instrument assisted therapeutic massage; and specific spinal manipulation therapy delivered manually and via instrument.
Results:
After approximately seven months of treatment consisting of 68 visits, the patient reported 0/10 head pain with no exacerbation of head pain by any stimulus. The patient is able to tolerate loud noises without the use of his noise canceling headphones and he no longer experiences flashes of bright white lights or diplopia. Cervical compression pain exacerbation had resolved and the patient was able to return to school. Post testing with VNG revealed a dramatically increased optometric performance for all tests and performing the test did not induce the sensation of nausea or vertigo. Post CAPS testing did not show an improvement.
Conclusion:
In conclusion, several patient specific methods of neurorehabilitation were shown to be effective for this patient with post concussive syndrome. Further research is warranted to explore continued efficacy and repeatability of this type of therapy to help other patients who display similar symptoms of pathology.
Keywords:
Traumatic brain injury (TBI),
Headache,
Post-Concussion Syndrome,
Chiropractic,
Neurorehabilitation
Conference:
International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function, Orlando, United States, 7 Oct - 9 Oct, 2016.
Presentation Type:
Poster Presentation
Topic:
Abstracts ISCN 2016
Citation:
Ellis
M,
Arkin
J and
Esposito
SE
(2016). Neurological rehabilitation of a patient with unrelenting head pain associated with post-concussive syndrome.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function.
doi: 10.3389/conf.fneur.2016.59.00012
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Received:
29 Aug 2016;
Published Online:
07 Sep 2016.
*
Correspondence:
Dr. Susan E Esposito, Life University, Marietta, United States, susanesposito@gmail.com