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Improvements in Processing Speed, Stability Score, and a Decrease in Symptom Severity Score Following Neurological Rehabilitation for a 43-year-old Female Patient with Post Concussive Syndrome and a Centrally Maintained Vestibulopathy

Emily R. Kalambaheti1*, Megan Manno2 and Matthew M. Antonucci1, 3
  • 1 Plasticity Brain Centers, United States
  • 2 University of Central Florida, United States
  • 3 Carrick Institute, United States

Presentation: A 43-year-old female patient presented to Plasticity Brain Centers for evaluation and treatment of persistent symptoms following a concussion that occurred three months prior. Her symptoms included difficulty walking, changes in job performance, memory lapses, and confusion of left and right. Findings: Upon intake, she reported on the graded symptom checklist (GSC) (Simon 2017) a symptom severity score of 124. During neurocognitive testing on the C3 Logix program, her Trails B time was 44.0 seconds and digit symbol matching score in one minute was 53. A Comprehensive Assessment of Postural Systems (CAPS®) (Pagnacco 2014) was performed assessing balance and stability, on both a solid and foamed surface, with eyes opened, eyes closed, and with multiple head positions. The average stability score on intake was calculated as 78.35%. Methods: A 5-day, multi-modal program of neurological exercises was administered in 10 one-hour treatment sessions (Carrick 2017). Each session consisted of repetitive peripheral somatosensory stimuli, cognitive exercises, neuromuscular reeducation exercises, vestibular rehabilitation exercises, orthoptic exercises, and off-vertical axis rotation (Gdowski 1999) utilizing a multi-axis rotational chair (MARC). Outcome: Upon exit, the symptom severity score decreased to 29 (-76.61%). Trails B time decreased to 33.7 seconds (-23.41%). Digit symbol matching score representing processing speed was 68 (+22.06%). Stability scores improved, with the average stability score calculated as 86.80% (+10.78%). Conclusion: The authors suggest further investigation into multi-modal, intensive approaches to decrease symptom severity and improve processing speed and balance in patients with Post Concussive Syndrome and a Centrally Maintained Vestibulopathy.

Acknowledgements

The authors would like to thank and acknowledge the contribution of the clinical team at Plasticity Brain Centers, as well as the administrative support team. The authors would also like to thank the Carrick Institute for providing the education utilized to create the multi-modal treatments implemented in this case study.

References

1. Carrick FR, Clark JF, Pagnacco G, Antonucci MM, Hankir A, Zaman R and Oggero E (2017) Head–Eye Vestibular Motion Therapy Affects the Mental and Physical Health of Severe Chronic Postconcussion Patients. Front. Neurol. 8:414. doi: 10.3389/fneur.2017.00414

2. Gdowski GT, McCrea RA. Integration of vestibular and head movement signals in the vestibular nuclei during whole-body rotation. J Neurophysiol (1999) 82:436–49

3. Pagnacco G, Carrick FR, Wright CH, Oggero E. In-situ verification of accuracy, percision and resolution of force and balance platforms. Biomed Sciences instrumentation (2014) 50:171-8

4. Simon M, Maerlender A, Metzger K, Decoster L, Hollingworth A, McLeod TV. Reliability and Concurrent Validity of Select C3 Logix Test Components. Developmental

Neuropsychology (2017) Oct; 0: 1-14. Doi: 10.1080/87565641.2017.1383994. Epub 2017 Oct 25.

Keywords: Post-Concussion Syndrome, Post-concussive syndrome, balance, Neurorehabilitation, central vestibular disorders, centrally maintained vestibulopathy, processing speed, concussion rehabilitation, concussion

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: Kalambaheti ER, Manno M and Antonucci MM (2018). Improvements in Processing Speed, Stability Score, and a Decrease in Symptom Severity Score Following Neurological Rehabilitation for a 43-year-old Female Patient with Post Concussive Syndrome and a Centrally Maintained Vestibulopathy. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience 2018. doi: 10.3389/conf.fneur.2018.60.00030

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Received: 28 Mar 2018; Published Online: 14 Dec 2018.

* Correspondence: Dr. Emily R Kalambaheti, Plasticity Brain Centers, Orlando, United States, Emily.Kalambaheti@gmail.com