Improvement of spasticity in the extremities and in the quality of life of a patent with a severe hypoxic brain injury, using a combination of vestibular and functional rehabilitation
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1
Innova Brain Rehabilitation, United States
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2
Life University, United States
Objective:
Demonstrate the ability of vestibular and functional rehabilitation to recover cognitive and functional ability in a 28-year-old male after a severe hypoxic brain injury.
Clinical Features:
Patient is a 28-year-old male that suffered a severe hypoxic brain injury, secondary to a drug overdose, 8 years prior to consultation. After the initial hypoxic event, the patient was stabilized and receiving care at a rehabilitation center. His ability to move and perform activities of daily living were severely diminished, his ability to communicate was reduced but present. When receiving treatment, he had a refractory experience following administration of valproic acid which accounted for a loss of 8 months of previous treatment. Following this regression, the patient became aphasic, needed an insertion of a percutaneous endoscopic gastrostomy tube (PEG tube) and had virtually no control of head movement. He developed severe photophobia and was unable to speak other than a low-pitched moan. Patient presented to the clinic with left exotropia with accompanying ptosis and an inability to verbally express himself. He maintained marked flexion of elbows and slight spasticity in the lower extremities. A severe kyphotic posturing was noted in the cervical and thoracic spine. Patient could maintain a modified upright posture using an upright walker but could only ambulate with assistance from parents. Assistance was needed to carry out activities of daily living.
Interventions and Outcomes:
Patient received an intensive period of treatment consisting of four days with three treatment sessions per day. Repetitive somatosensory stimulation (RPSS) protocol was performed in the trigeminal distribution area V2 bilaterally. Off vertical axis whole body rotations were performed in a fixed position a total of three times, with a bias toward the left. Tonal therapy with a frequency of 407.61 Hz plus or minus 30 Hz was employed. Additionally, contemporary music written in a minor key, as a specific form of auditory stimulation, was also played. Median nerve stimulation using symmetrical biphasic current was performed in intervals of three with an intensity 4.2 mA at 35 Hz on both left and right wrists. Extra spinal manipulations were performed at the scapulothoracic junction. Whole body rotations using an off vertical axis rotational device (OVARD) reduced the patient’s resting heart rate and alleviated spasticity in upper extremities. As a result of these treatments, the patient was able to react to commands more appropriately and quickly. Tonal therapy was shown to calm the patient and increase the ability of the patient to maintain gaze and fixation. Spasticity was greatly reduced following the RPSS treatment in the anterior neck, rhomboids, trapezius muscle and hamstrings. Following the intensive period of treatment, the patient had a reduction in the frequency of moans, as reported by his parents.
Conclusions:
Intensive RPSS and specific whole-body rotation treatment was shown to improve spasticity of extremities and quality of life in this case of hypoxic brain injury. More research is indicated to explore the potential effects of this type of therapy.
Keywords:
hypoxic,
Brain Injury,
vestibular rehab,
Functional rehabilitation,
RPSS
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:
Duffy
JL,
Weston
NW and
Esposito
SE
(2018). Improvement of spasticity in the extremities and in the quality of life of a patent with a severe hypoxic brain injury, using a combination of vestibular and functional rehabilitation.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience 2018.
doi: 10.3389/conf.fneur.2018.60.00133
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Received:
08 Apr 2018;
Published Online:
14 Dec 2018.
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Correspondence:
Dr. Susan E Esposito, Life University, Marietta, United States, susanesposito@gmail.com