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Improvements in Processing Speed, King Devick Test Time, Fluid Cognitive Abilities, Stability Scores and a Decrease in Symptom Severity Scores Following Neurological Rehabilitation for a 53-year-old Female Patient with Post-Concussive Syndrome with Centrally Maintained Vestibulopathy



Emily R. Kalambaheti1*, Matthew M. Antonucci1, 2, Michael Greenwell1 and Mia Cozart3

1Plasticity Brain Centers, United States

2Carrick Institute, United States

3University of Central Florida, United States

Presentation: A 53-year-old female patient presented to Plasticity Brain Centers for evaluation and treatment of Post-Concussive Syndrome (PCS) with Centrally Maintained Vestibulopathy (CMV). Her symptoms included oculomotor dysfunction, issues with focus and processing, and brain fog.

Findings: Upon intake, with neurocognitive testing on the C3 Logix program, her Trails A time was 58.6 seconds (50th percentile being 24.4 seconds) and her Trails B time was 103.2 seconds (50th percentile being 47.1 seconds). Her digit symbol matching score was 41 correct in 120 seconds (50th percentile being 56). A Comprehensive Assessment of Postural Systems (CAPS®) (Pagnacco 2014) was performed assessing balance and stability, on both a solid and foamed surface, with eyes opened, eyes closed, and with multiple head positions. Her overall average stability score was 44.43%. She reported on the graded symptom checklist (GSC) (Simon 2017) a symptom severity score of 61. She completed the King Devick three-card baseline test in 222.5 seconds.

Methods: A 5-day, multi-modal program of neurological exercises was administered in 10 one-hour treatment sessions (Carrick 2017). Each session consisted of repetitive peripheral somatosensory stimuli, cognitive exercises, 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, Trails A time decreased to 25.6 seconds (-56.31%) and her Trails B time was 47.4 seconds (-54.07%). Digit symbol matching score representing processing speed was 56 correct in 120 seconds (+36.59%). Stability scores improved, with the average stability score calculated as 80.93% (+82.11%). Her symptom severity score decreased to 12 (-80.33%). She completed the King Devick three-card baseline test in 106.0 seconds (-52.36%).

Conclusion: The authors suggest further investigation into multi-modal, intensive approaches to improve processing speed, King Devick test time, fluid cognitive abilities (Salthouse 2011), stability scores and decrease symptom severity scores in patients with PCS with CMV.

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. 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 
  3. Pagnacco G, Carrick FR, Wright CH, Oggero E. In-situ verification of accuracy, percision and resolution of force and balance platforms. Biomed Sciences instrumentation (2014) 50:171-8 
  4. 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. 
  5. Salthouse T. What Cognitive Abilities are Involved in Trail-Making Performance? 
    2011 July-August; 39(4): 222–232. 

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