Improved symptomatology and objective findings in post-concussion syndrome through multimodal therapeutic applications
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1
Innova Brain Rehabilitation, United States
Objective: Discuss improvement of subjective complaints and objective findings in a case of post-concussion syndrome after a week of visual, vestibular, neuromuscular, and auditory training.
Clinical Features: Forty-four year old female subject with a history of light and sound sensitivity, sleep disorder, working memory issues, cognitive flexibility issues, and other cognitive deficits. Symptomatology began with a head injury sustained in a car accident 1-year prior. Examination revealed the following: fixed pupils with 1mm pupillary constriction bilaterally; convergence insufficiency with facial grimace and head pain; aversion, facial grimace, and head pain from 128hz and 512hz tuning forks in either ear; Video-oculograpy (VOG) testing revealed marginal saccadic velocities in the horizontal plane; balance deficits throughout static and dynamic posturography.
Interventions: Visual, vestibular, neuromuscular, and auditory training were administered during three daily treatment sessions over the course of four days. Therapies included gaze stabilization exercises with and without forward translation, electrical stimulation procedures, therapeutic application of 100hz tones with bone conducting headphones alternating between bilateral and right sided applications, spinal manipulation, and blue colored lenses.
Outcomes: Significant improvement was observed on the fourth treatment day with the following: increased amplitude of resting pupil size and 3mm pupillary constriction, resolution of sensitivity to convergence and 128hz and 512hz tones in both ears, increased saccadic velocities rated as fast in the horizontal plane on VOG testing, and an increase in stability scores in every category of static and dynamic posturography with an average percent increase of 18.7%. Follow-up interview with the patient revealed marked improvement of sound and light sensitivity complaints as well as improvements in cognitive flexibility and working memory.
Conclusions: A multimodal rehabilitation approach provided subjective and objective improvement in long standing post-concussion symptoms. Full resolution was not achieved over 4 days of therapy, but this case warrants further therapeutic application and greater investigation. Follow-up in both areas are needed to establish a therapeutic approach for improvements in the realm of post-concussion syndrome.
Keywords:
Post-Concussion Syndrome,
Pupillary constriction,
light sensitivity,
sound sensitivity,
working memory,
cognitive flexibility,
Vestibular Rehabilitation,
Dynamic posturography,
video- oculography,
canal repositioning maneuver
Conference:
International Symposium on Clinical Neuroscience 2018, Orlando, Florida, United States, 24 May - 26 May, 2018.
Presentation Type:
Poster
Topic:
Clinical Applications in health, disease, and injury to the nervous system
Citation:
Patterson
FE
(2018). Improved symptomatology and objective findings in post-concussion syndrome through multimodal therapeutic applications.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience 2018.
doi: 10.3389/conf.fneur.2018.60.00063
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Received:
01 Apr 2018;
Published Online:
14 Dec 2018.