MULTIMODAL NEUROREHABILITATION PROGRAM IMPROVES REFRACTORY DEPRESSIVE SYMPTOMS AND BEHAVIORS IN A 19 YEAR OLD WOMAN.
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1
Carrick Institute, United States
Background:
A 19 year old female presented with a multiple year history of depression and anxiety. She had been hospitalized three times due to suicidal behavior. She had been treated by the author previously starting at age 17 using diet and specific supplementation. She had been doing well until she left home for college, which triggered a severe depressive episode. At time of presentation she was taking Lamictal® and Zoloft®.
Methods:
Neurological examination revealed decreased right arm swing compared to the left side during normal gait, and with serial subtraction of sevens dual-tasking elicited an immediate hesitation. Fist-making and finger-tapping tests were Grade 1 on Unified Parkinson's Disease Rating Scale (UPDRS) when she dual-tasked with serial subtraction of threes from 30. She was generally hyper-reflexive and percussion myotonia on the right thenar eminence. She had mild left cerebellar decomposition of movement during finger-nose-finger. Bedside examination of pursuits showed large intrusions in vertical pursuits both traveling upward and downward. Saccades tested at bedside showed slow leftward saccades. She had a plastic left pupil.
Ober Saccadometer testing showed normal latencies, but a significant asymmetry between rightward and leftward saccades. Leftward saccades peak mean velocity was 609 deg./second and for rightward saccades 422 deg./second. Q-Factor for leftward saccades was 1.72 and for rightward saccades 2.18.
She was enrolled in a comprehensive multimodal neurorehabilitation program utilizing Interactive Metronome® training with emphasis on right-sided tasks and tasks using the feet, vertical pursuit training with head motion reinforcement, FitLight® trainer and prone neck raises.
Results:
At two weeks post-treatment she was assessed again. Her mother reported that the patient showed increased smiling, more time engaged and talking with her family, more sharing and initiating conversations. All of these improvements in mood were confirmed by the patient's treating psychiatrist. The patient was working as a nanny for two different families, and she was accepted into another university.
Her Interactive Metronome® task average scores improved despite not having trained for 2 weeks: for the both hands task, 21 ms compared to 24 ms and for the both toes task, 24 ms compared to 29 ms two weeks prior. At seven weeks post-treatment the gains in mood had been maintained.
Conclusion:
The author suggests further investigation into treating refractory depression with different forms of multimodal neurorehabilitation.
Keywords:
Interactive metronome,
Depression,
Neurorehabilitation,
dual-tasking,
pursuit eye movements
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:
Clark
DJ
(2018). MULTIMODAL NEUROREHABILITATION PROGRAM IMPROVES REFRACTORY DEPRESSIVE SYMPTOMS AND BEHAVIORS IN A 19 YEAR OLD WOMAN..
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience 2018.
doi: 10.3389/conf.fneur.2018.60.00024
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Received:
26 Feb 2018;
Published Online:
14 Dec 2018.
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Correspondence:
Dr. David J Clark, Carrick Institute, Cape Canaveral, United States, mail@doctordavidclark.com