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Improvements in Cognition and Processing Speed Following Neurological Rehabilitation for a 49-year-old Female Patient with Post Concussive Syndrome



Emily R. Kalambaheti1*, Megan Manno2 and Matthew M. Antonucci1, 3

1Plasticity Brain Centers, United States

2University of Central Florida, United States

3Carrick Institute, United States

Presentation: A 49-year-old female patient presented to Plasticity Brain Centers for evaluation and treatment of post concussive syndrome following to a motor vehicle collision with the following symptomatology: memory lapses, fatigue, brain fog, pain, and anxiety.

Findings: When asked to rate her symptoms on a graded symptom checklist (GSC) (Simon 2017), she reported a score of 66. On the standardized assessment of concussion, she scored 24 out of 30. Her Trails B time was 59.6 seconds (50th percentile being 47.1 seconds). Her digit symbol matching score on the processing speed test was 49 in 120 seconds (50th percentile being 56). On the King Devick (Galleta 2015) (Olson 2017) 3-card baseline test, she received a score of 62.9 seconds.

Methods: A 5-day, multi-modal program of neurological exercises was administered in 10 one-hour treatment sessions (Carrick 2017) that consisted of repetitive peripheral somatosensory stimuli, 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 17 (-74.2424%). The standardized assessment of concussion score increased to 29 (17.2413%); Trails B was 45.9 seconds (-22.987%); digit symbol matching score was at 56 (12.5%). The King Devick score decreased to 48.3 seconds (-23.211%).

Conclusion: The authors suggest further investigation into multi-modal, intensive approaches to decrease symptom severity and improve standardized assessment of concussion scores in patients with Post Concussive Syndrome.

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. Galetta KM, Liu M, Leong DF, Ventura RE, Galetta SL, Baleer LJ. (2015) The King-Devick test of rapid number naming for concussion detection: meta-analysis and systematic review of the literature. Concussion. (2015) doi: 102217/cnc.15.8 
  3. 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 
  4. Olson BL, Oberlander TJ, Weidauer L (2017) Test-Retest Reliability of the King-Devick Test in an Adolescent Population. J of Athletic Training. 2017;52(2):000–000. doi: 10.4085/1062-6050-52.2.12 
    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.

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