Multimodal Neurorehabilitation of Post-Concussive Athlete
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1
Bagnell Brain Center, United States
Background
A 17-year-old hispanic male baseball player presented with chief complaints of neck tension and visual difficulty during sports participation. He was struck on the left posterior occipital skull by a pitch during a baseball game in 2016. Following concussion protocol which included passive rest, he was cleared by physicians to return to participation. During physical activity the patient experienced headaches, an inability to focus on the ball during practice, photophobia, phonophobia, anxiety, and neck pain. Physical exertion above 50% increased symptomatology. Self-graded assessments revealed decreased attention span, difficulty concentrating, emotional lability, impulsivity, rumination, dysphagia, tachycardia and sleep difficulties.
Methods
A C3 Logix neurocognitive battery was performed. The battery included digit symbol matching, reaction time, choice reaction times, immediate and delayed memory, visual acuity and dynamic visual acuity. Clinical Testing of Sensory Integration and Balance (CTSIB) was measured on Biodex Biosway with >2 standard deviations with eyes open on perturbed surface below normative age/height matched values.Testing revealed changes in Trails A and Trails B tests, reaction time, choice reaction times, visual acuity and dynamic visual acuity. Maddox rod testing revealed left eye hypertropia. The right eye demonstrated increased convergence. Saccadometer testing revealed bilateral hypometria with dysmetria. Neurosensory motor exam revealed a left OPK stimulus response asymmetry, diminished right arm swing on gait analysis, right lower facial paresis, saccadic intrusions on horizontal smooth pursuits bilaterally, and dysmetria on left finger to nose testing. Head Impulse Testing (HIT) to the left exacerbated symptoms.
Treatment
RPSS (repetitive peripheral sensory stimulation) was applied over trigeminal and hypoglossal nerve branches daily. Complex, multi-joint, out of phase exercises were delivered passively and eventually performed actively by the patient. Spinal manipulative therapy (SMT) was combined with fascial release techniques and applied to the cervical region. Interactive Metronome was integrated daily. Neurosensory visual training included passive gaze stabilization, pro-saccades, reactive saccadic exercises, and Brock bead string exercises.
Results
Diagnostics were performed following sixteen treatments over 2.5 weeks. Saccadometer evaluation showed improved metrics and velocities. Increased stability was noted on perturbed surfaces with eyes open. C3 Logix follow up revealed improvements in reaction time (10%), choice reaction time (7%), digit symbol matching (9%), and trails A & B (18% and 12% respectively). Symptom severity decreased by 83%. The patient noted sharper clarity on the ball during batting and catching as well as improved fielding and running.
Conclusion
The improvement seen in this patient warrants further investigation into the analysis and treatment of post-concussive syndrome utilizing advanced assessment technology and specific multimodal neurorehabilitation based on recent clinical neuroscience evidence.
Keywords:
Post concussion syndrome,
Clinical Neuroscience,
Athletes,
Brain Based Rehabilitation,
Baseball
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:
Bagnell
DK,
Irons
H,
Schmidt
M and
Coppus
JA
(2018). Multimodal Neurorehabilitation of Post-Concussive Athlete.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience 2018.
doi: 10.3389/conf.fneur.2018.60.00043
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Received:
17 Jan 2018;
Published Online:
14 Dec 2018.
*
Correspondence:
Dr. Dr. Michael K Bagnell, Bagnell Brain Center, Miami, FL, 33157, United States, bagnelldc@gmail.com