Peripheral Neurological Complaints Improve with Brain-Based Care, Following Previous Surgical Intervention
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1
Bagnell Brain Center, United States
Background: A 61-year-old female patient presented with low back pain, cramping in her legs, “electric shocks” down both arms, and intermittent numbness in both hands, following a car accident and recent C5-7 spinal fusion. She was in a motor vehicle accident a year prior, which required her to have rotator cuff surgery and the cervical spine fusion. She also reported difficulty staying asleep and awaking multiple times in the night. The patient also reported difficulty with standing in the shower with her eyes closed. She was also diagnosed with Type II Diabetes at the age of 45-years-old for which she takes Insulin.
Methods: Physical exam findings included decreased right arm swing with a right lateral pulsive gait, made worse by dual tasking. Hyperesthesia was reported on the left side of the face. There was decreased sensation of the lower extremities worse on the left. Decreased left finger tapping, decreased left Luria, decreased left dysdiadochokinesia, and hypometric finger-to-nose testing were observed. The patient could not perform tandem gait and felt unsteady during Romberg’s test. C3 Logix assessment: 32/162 symptom severity, 55s Trails A, Choice Reaction Time 568ms (average 430ms). The patient was unable to perform Trails B. Saccadometer testing demonstrated an increased spread in the velocity plot varying from 90 to 265˚/sec. Clinical Test for Sensory Integration and Balance (CTSIB) testing was performed which showed that the patient was three standard deviations outside the normative database with eyes open on a firm surface and perturbed surface, while two standard deviations outside the normative database with eyes closed on a firm surface. The patient’s overall composite score was three standard deviations from average.
Patient specific treatment consisted of repetitive peripheral somatosensory stimulation (RPSS) over the median nerve, tibial nerve, as well as the mandibular (V3) and maxillary (V2) distribution of the trigeminal nerve bilaterally; single dot gaze stability exercises with whole body rotation; bilateral complex movements of the upper and lower extremities.
Results: C3 Logix post testing demonstrated improvements in Trails A from 55 seconds to 37.2 seconds and choice reaction time from 568ms to 526ms. Post saccadometer testing showed an increase in the velocity plot from 200 to 300˚/sec. CTSIB testing showed improvement with eyes open on a firm surface, the patient’s sway index improved from three to one standard deviation outside the normative database, as well as with eyes closed on a firm surface sway index improved to within normal limits of the normative database. With eyes open on a perturbed surface sway index was improved but remained three standard deviations outside the normative data range, and eyes closed on a perturbed surface was not completed. The patient reported sleeping through the night, having more energy, decreased numbness in her both hands, and no longer experienced cramping in her legs. She also reported being able to stand with her eyes closed in the shower without feeling unsteady.
Conclusion: This case demonstrates the importance of brain based care on a post-surgical patient with residual or unresolved complaints. Improvements observed on this patient highlight the need for continual research into brain based approaches to health care.
Keywords:
Spinal Fusion,
Clinical Neuroscience,
Diabetes Mellitus, Type 2,
Dizziness,
Rehabilitation
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:
Coppus
JA,
Bagnell
DK,
Schmidt
M and
Irons
H
(2018). Peripheral Neurological Complaints Improve with Brain-Based Care, Following Previous Surgical Intervention.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience 2018.
doi: 10.3389/conf.fneur.2018.60.00033
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Received:
15 Jan 2018;
Published Online:
14 Dec 2018.
*
Correspondence:
Mr. Joseph A Coppus, Bagnell Brain Center, Miami, Florida, 33157, United States, joseph.coppus@student.life.edu
Dr. Dr. Michael K Bagnell, Bagnell Brain Center, Miami, Florida, 33157, United States, bagnelldc@gmail.com