Improvements in Anxiety and Cognitive Function in a Middle Aged Female Using Multimodal Neurological Rehabilitation

Background: A 56-year-old female patient presented with complaints of anxiety, inability to focus on a task, and difficulty with comprehension. Additionally, she reported feeling overwhelmed when information “comes too fast”. She also had difficulty with her sense of direction as well as feeling uncoordinated. She has a history of concussion 34 years ago. She expressed having concerns that her mother had dementia, and that she wanted to retain or hopefully improve her current level of brain function.

Methods: Physical exam findings included abnormal eye movements during pursuits that showed catch-up saccades during downward tracking. This motion was smoother when following a target down and right. She displayed confusion and an inability to perform antisaccades after 2 repetitions. Examination of her gait showed a decreased right arm swing that was absent with dual tasking. Videonystagmography (VNG) testing measured hypermetric horizontal pursuits with catch-up saccades at 0.2 and 0.4hz speeds and saccadic intrusions of pursuits were noted in the vertical plane at 0.2 and 0.4hz. Additionally, low amplitude square wave jerks were noted with occluded vision indicating a resting nystagmus. During saccadometry testing latent saccades were noted showing a poor cortical decision time. Based on the above findings, a course of treatment was implemented which included vestibular rehabilitation, gaze stability with head movements, eye exercises, and the use of an off vertical axis rotation device (OVARD).

Results: At the end of a 5-day course of treatment, the patient had improvements in her symptomatology reporting significantly reduced anxiety. She noted that the “chatter in her head” had cleared and she felt she was better able to make decisions in stressful situations. The patient was observed to have smooth, metric pursuits horizontally, and less saccadic intrusions on downward pursuits. Additionally, her arm swing had increased in amplitude on the right and further improved with dual tasking. The patient was able to perform antisaccades with no breakdowns. Her follow-up VNG demonstrated less frequent square wave jerks with eyes occluded, metric horizontal pursuits, and less frequent saccadic intrusions during pursuits in the vertical plane. Post saccadometry measures displayed an increased number of metric saccades.

Conclusion: This case shows significant improvements as a result of a patient specific, integrated neurological rehabilitation regimen. The authors suggest further investigation into the mechanisms of brain-based approaches for patient treatments with cognitive dysfunction for improvement in human performance.