Mixed clinical results following multimodal treatment of a hockey coach with chronic, progressive post-concussion syndrome
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1
Innova Brain Rehabilitation, United States
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2
Life University; College of Chiropractic, United States
Background:
A 40-year-old male hockey coach presented to a chiropractic neurology clinic with right-sided headaches, mental fogginess, anxiety, slowness with thinking, and a general lack of motivation. He also complained of blurred vision and hyperacusis. He described tightness in his right leg and generalized pain on the right side of his body. The patient had a history of six concussions from playing hockey with symptoms progressing gradually over the past 12 years.
Methods:
Postural findings utilizing Computerized Dynamic Posturography (CDP) revealed widespread instability with eyes open and closed in multiple head positions including right and left rotation, as well as flexion and extension. When placed on a perturbed surface with the eyes closed and the head in an extended position he had a low stability score of 54.7%. Videonystagmography (VNG) was employed to quantitatively measure eye movements. A finding of hippus was observed in all directions of fixed gaze as well as in horizontal pursuits and upward and downward saccades. Saccades were found to be hypometric. Optokinetic (OPK) testing revealed low amplitude movements with protracted slow phases with leftward, rightward and downward stimulation. Examination of the patient’s gait showed a decreased right arm swing with freezes on dual tasking. Sensory findings included pinwheel and light touch hypoesthesia at multiple dermatomes, and hyperesthesia to vibration at the patient’s left knee. The initial working diagnosis was post concussive syndrome (PCS). A five-day treatment plan was implemented which focused on neuromuscular re-education and vestibular rehabilitation, including gaze stabilization and cortical exercises targeted at stimulating deficient neural networks.
Results:
Upon completion of five days of multiple rounds of treatment, his CDP improved overall and his most unstable position of eyes closed, perturbed surface, head extended improved to a stability score of 74.6%. Eye movements assessed by the VNG found that the patient’s gaze holding, pursuits, and saccades became normalized in all directions without hippus or hypometria. Also, the OPK reflex had improved amplitude in all directions of stimulation. His subjective findings, such as headaches, showed mild improvement in intensity and duration; however, there was no improvement in his mental fogginess or anxiety levels. The patient was discharged with a home therapy program targeting the same neural networks with recommendation of biweekly follow-up e-mails to track results.
Conclusion:
Short-term clinical treatment resulted in positive objective outcomes with moderate subjective improvement. Further research into the long-term brain-based treatment of PCS is recommended to better understand the presence of a potential subjective and objective correlation for this case.
Keywords:
Post concussion syndrome,
Chiropractic,
Anxiety,
Headache,
male,
Humans,
Traumatic Brain Injury
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:
Keiser
ND,
Coppus
J and
Mullin Elkins
L
(2016). Mixed clinical results following multimodal treatment of a hockey coach with chronic, progressive post-concussion syndrome.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function.
doi: 10.3389/conf.fneur.2016.59.00033
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Received:
29 Aug 2016;
Published Online:
07 Sep 2016.
*
Correspondence:
Dr. Linda Mullin Elkins, Life University; College of Chiropractic, Marietta, GA, 30060, United States, mullin@life.edu