Amelioration of pain and post-concussive symptoms using multi-modal neurorehabilitation strategies in a 28-year-old male
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1
Life University, United States
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2
Southwest Brain Performance Center (SBPC), United States
Presentation:
A 28-year-old male US air force captain presented to a chiropractic neurology clinic with chief complaints of frequent migraines, insomnia (sleeping only 1 to 4 hours nightly), and severe constant neck and back pain radiating down all extremities. He also complained of vision problems, sensitivity to fluorescent lights and lightheadedness. He reported that turning his head sometimes caused him to feel as if the room was spinning and that he felt nausea when riding in a car. He stated that these complaints started as a result of a MVA in 2014, when he had hit his head on the post between the car doors but did not lose consciousness. He claimed that all his symptoms had intensified over the last 3 months, over which time he had been receiving cervical facet injections. Additionally, over the last 3 months he had experienced difficulties with word retrieval, blacking out for short periods of time and short-term memory loss, burning and a “terrible sharp pain” that had him doubled over which radiated from inside his stomach. He stated that he had experienced a period of been unable to eat for 8 days, but his chiropractor put him on an anti-inflammatory diet, which enable him to eat again. He had a colonoscopy and an endoscopy performed, with normal results. The patient had an MRI after that accident that appeared normal, but the latest MRI from March 2018 showed signs of cortical shrinkage. He had been receiving chiropractic adjustments that he claimed reduced his pain and migraines to a level that allowed him to work. He took daily doses of baclofen and amitriptyline.
Findings:
Comprehensive neurological examination revealed the following positive findings: finger tapping test was graded 1 on the right for decreased amplitude and alternating palms up/down testing showed mild dysdiadochokinesia bilaterally. Upon gait testing, that patient had a grade 1 decreased amplitude right arm swing with no observed hesitations and upon dual tasking had a grade 2 decreased amplitude of right arm swing with 3 - 5 hesitations. Frenzyl goggle testing revealed one large right square wave jerk (SWJ) followed by a 1Hz left beating nystagmus for 6 beats. Cover/uncover testing showed a right hypertropia. Saccadic intrusions were observed on upward pursuit testing. Accommodation testing evoked saccadic intrusion on the right eye. Saccadic testing revealed dysmetria of eye movement and hippus in the upward, leftward and rightward directions. During anti-saccades testing, the right eye showed large spontaneous right beating nystagmus for about 3-4 beats during rightward saccades. Minimal optokinetic (OPK) nystagmus was observed during leftward OPK stimulation and evoked a left ptosis. Head thrust testing in right yaw created 2 beats of nystagmus. Bilateral hippus was observed on light reflex testing. The patient had a weak gag reflex upon testing with decreased elevation of his soft palate bilaterally. Computerized Assessment of Postural Systems (CAPS) testing revealed most notably 89% stability on a non-perturbed surface, eyes open, head neutral (NSEO-HN), and 95% stability on a non-perturbed surface, eyes closed, head neutral (NSEC-HN), and 58% stability on a perturbed surface, eyes closed, head in extension (PSEC-HE). His Right EyeTM brain health Q score was 88 out of 100. The Rivermead Post-Concussive Symptoms Questionnaire (RPSQ) was scored a 38 out of 64 and the Subjective Units of Distress Scale (SUDS) was graded a 50 out of 100. QEEG brain mapping revealed some bilateral frontal slowing and bilateral dysregulation of alpha waves in the parietal and occipital lobes. Spinal and pelvic joint musculoskeletal analysis revealed multiple subluxations with spasm, hypomobility and end point tenderness were found at the following levels; left C1, C2, C3, left C4, left L5 and right sacrum. Rib subluxations were noted at T2, T3, T4, T5 and T6 on the left.
Methods:
The patient was treated daily for a total of three sessions per day for a duration of one week and then approximately one day a month for the next 4 months. The treatment plan for this patient was a multi-modal integration of the following procedures: transcutaneous non-invasive vagal nerve stimulation using High Volt Galvanic at 3 microampere's to the tragus of the left ear for 25 minutes, Cranial Nerve Non-Invasive Neuromodulation (CN-NINM) using micro-current stimulation at 3 Hz was used therapeutically on the left V1, V2 and V3/hypoglossal cranial nerves with an amplitude of 4.0 Hz for 15 seconds on each area and was repeated 3 times (three sets were performed), a rightward BBQ roll, rightward saccades with and anti-saccades with right carotid compressions (2) after each set, right Eye QTM exercises, right vestibulo-ocular cancellation exercises combined with rightward head thrusts, vertical saccades exercises, OPK stimulations to the left, upwards and downwards,, left brain eye exercises utilizing the Focus BuilderTM app on an iPad using right/upward diagonal microsaccades (8) immediately followed by left/downward diagonal smooth pursuits (two repetitions and three sets), neurosensory integrations using numbers and letter as targets overloaded to the left side, gait therapy around five obstacles in a straight line (patient started on the right side of the first target and walked sinusoidally around the three middle targets and performed full left turns on the end obstacles (four repetitions were performed with dual tasking), low level laser therapy using the ErchoniaTM FX 635 was applied to increase Interleukin 10 (anti-inflammatory hormone), increase ATP production from the mitochondria, to increase blood flow, reduce inflammation and coordination of the involved areas. The therapy was performed for approximately 5 minutes on 4-40-9 frequencies to the left frontal lobe and right cerebellum. At home exercises were additionally given to the patient. They consisted of gargling to the point of lacrimation 5 sets daily, initiating self-gagging while brushing teeth, and humming and singing. In subsequent visits these treatments were modified or added to according to the response of the patient. For example, convergence and divergence exercises were added using brock beaded string for 5 targets, the closest at 5” and the farthest at 60”. Joint manipulations were performed at subluxated vertebral and/or rib levels.
Outcome:
The patient stated feeling “70-80% better”. He reported a significant decrease in pain from severe to very mild. He reported that for the first time since his accident he experienced windows of time that were pain free. He was now able to work out at the gym, go rock climbing twice a week and handle double his load at work. His frequent migraines decreased in frequency to only once a month. He was able to sleep 7 hours per night and felt increased energy. His dysmetria, eye movements and hippus showed significant improvements. CAPS testing results improved to 95% stability on NSEO-HN, remained at 95% on NSEC-HN, and greatly improved to 75% on PSEC-HE. His Right EyeTM brain health Q score increased to 91 out of 100. RPSQ score decreased to 23 out of 64 and his SUDS decreased to 30 out of 100.
Conclusion:
The significant pain modulation and neurological function that was achieved in this case warrants further research into the integration of multi-modal chiropractic functional neurology treatments in patient care.
Keywords:
concussion,
Post-concussion symptom,
chiropractic neurology,
Functional Neurology,
Cervicalgia
Conference:
International Symposium on Clinical Neuroscience, Orlando, United States, 24 May - 26 May, 2019.
Presentation Type:
Poster Presentation
Topic:
Clinical Neuroscience
Citation:
Esposito
SE and
Pendleton
M
(2019). Amelioration of pain and post-concussive symptoms using multi-modal neurorehabilitation strategies in a 28-year-old male.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience.
doi: 10.3389/conf.fneur.2019.62.00001
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Received:
31 Mar 2019;
Published Online:
27 Sep 2019.
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Correspondence:
Mx. Susan E Esposito, Life University, Marietta, United States, susanesposito@gmail.com