Brain Based Neurological Treatment Approach to a Non-Ambulatory Patient Suffering from Headaches After Traumatic Brain Injury
Background: A 56 year old female patient presented with excruciating headaches and head pressure that has been present for 17 years after an head injury. She was unable to walk unassisted when she initially presented into the clinic.
Examination: The patient presented with a symptom count of 23/27 and a symptom severity of 98/162. During balance testing, on a perturbed surface with the head turned to the right with eyes closed, the patient overall stability score was 43.9%. Gaze stability after vertical saccades was greatly affected, with numerous spontaneous movements after each vertical movement. During Saccadometry testing, the latency mean of leftward saccades was 225 ms and peak velocity mean was 489 deg/s.
Results: The patient was treated over a four day span that included gaze stability exercises, repetitive peripheral somatosensory stimulation, chair rotations, and divergent eye exercises. After the first day of treatment, the patient was able to walk unassisted. The patient had a symptom count of 18 and symptom severity of 34 after treatment. Her stability on the perturbed surface in head right position with eyes closed increased to 68.5%. Vertical saccades showed greatly improved stability after each eye movement. Peak velocity mean of leftward saccades during saccadometry increased to 555 deg/s and the latency mean decreased to 166 ms.
Intervention: Based on the above findings, we started a course of treatment including tilt table therapy, vestibular rehabilitation, eye exercises, and repetitive peripheral somatosensory stimulation. The treatment comprised of chair rotations, gaze stability with head movements, and iPad exercises.
Conclusion: The rapid improvement of balance and neurological function indicate that brain-based treatment can be effective in the management of post-concussive symptoms including balance issues and headache.
Acknowledgments: The authors would like to thank Dr. Frederick Carrick and the Carrick Institute of Graduate Studies for the training and clinical neuroscience.
The authors would like to also thank Dr. Marc Ellis for the temporary utilization of his facilities for which this patient was seen and treated.
The authors would also like to thank Dr. Kelsey Brenner, Dr. Stuart Rutledge, Dr. Lon Kalapp, Dr. Eduardo Fontana, Dr. Ben Berendt for their assistance in patient treatment.