The application of functional neurology based treatment following multiple concussions
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1
Portland Chiropractic Neurology, United States
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2
Life University, United States
Background: A 33-year-old male diagnosed with a blood disorder with aplastic crisis presented with a history of multiple concussions, left sided shoulder, hip, and low back pain, delayed speech, dizziness upon quick head movements, vestibular migraine headaches, and mental fatigue with difficulty remembering names and recalling words. The patient reported progressive changes in his emotional state that included depression, panic attacks and anxiety. The initial concussions were attributed to playing hockey while the last and most severe concussion occurred in 2012 during an auto racing accident. Previous computed tomography scans of the head and neck were performed in 2012 that revealed unremarkable findings.
Methods: A complete functional neurological and physical examination was performed with quantifiable metrics being obtained from the Patient Specific Functional and Pain Scale (PSFP), Videonystagmography (VNG) testing and Computerized Dynamic Posturography (CDP) protocols. VNG findings demonstrated convergence insufficiency with prominent pupillary fatigue. Pulse-step dysmetria was elicited during upward and leftward saccadic activity that is suggestive of mesencephalic and right frontal lobe dysfunction. During pursuit testing, hypermetric saccadic intrusions were observed along with a prominent inability to pursue downwards and to the right. Rightward Optokinetic (OPK) stimulation exhibited a decrease in amplitude and frequency of OPK nystagmus that is suggestive of decreased right cortical functioning. This OPK finding correlated with previous examination findings of leftward pulse-step dysmetria. It was also noted that OPK stimulation induced nausea in the patient. CDP testing revealed that the patient’s center of pressure (COP) was translated to a rightward and anterior position with a predominant sway that occurred in a left anterior to right posterior diagonal plane. Further DNP testing exposed a paradoxical finding in which the patient’s fatigue ratio was decreased upon eye closure. This finding alluded to visual contaminations occurring while the eyes were open and subsequent abnormalities in postural mechanisms. Initial PSFP was graded as 5/10 for activities that require range of motion (ROM) in the back and neck, 4/10 when utilizing critical thought processes, and 5/10 regarding the ability to snowmobile. On this 0-10 scale, 0 = unable to perform the activity, whereas 10 = able to perform the activity at the same level as before the symptoms began. These combined findings suggested that there were consequential changes in the right cortical-left cerebellar/vestibular neuraxis and thus a treatment plan was devised in order to restore proper integrations and function in this area. A multidisciplinary treatment approach involving hyperbaric oxygen therapy (HBOT), chiropractic spinal manipulative therapy, physical therapy, proprioceptive neuromuscular facilitation training, myofacial release, cervical decompression therapy, and functional neurological rehabilitation intended to restore function and integration to the right cortical-left-cerebellar/vestibular neuraxis was implemented.
Results: The patient showed notable improvements in all PSFP score recordings. Activities requiring cervical and low back ROM scores improved to 7/10, thought process and critical thinking scores improved to 9/10, and activities such as snowmobiling improved to 7/10. VNG testing revealed minimal improvements. Horizontal pursuit mechanisms to the right revealed minor catch up saccades at a speed of 0.1hz that were attenuated at a velocity of 0.2Hz. Leftward OPK stimulation revealed appropriate nystagmus responses with mild dysmetria. Upward gaze holding mechanisms revealed improvements with a decrease in frequency and amplitude of rightward square wave jerks. Convergence mechanisms displayed a failure to converge with the left eye and a compensatory saccadic intrusion. CDP post findings revealed a decrease in fatigue ratio from the initial findings of 40.8% to 0% during the eyes open stability test.
Conclusion: This case revealed improvements in the patient’s PSFP scores, VNG findings and DNP metrics. The authors suggest that further investigations be done into understanding the mechanisms behind traumatic brain injuries, consequential effects of these mechanisms, and the potential treatment effects of functional neurology based treatment and subsequent changes in brain performance.
Keywords:
multiple concussions,
Dizziness,
Anxiety,
chiropractic neurology,
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:
MacArthur
A,
Klopfer
R and
Esposito
SE
(2016). The application of functional neurology based treatment following multiple concussions.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function.
doi: 10.3389/conf.fneur.2016.59.00026
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Received:
31 Aug 2016;
Published Online:
07 Sep 2016.
*
Correspondence:
Dr. Susan E Esposito, Life University, Marietta, United States, susanesposito@gmail.com