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Improvements in Processing Speed, Stability Score, and a Decrease in Symptom Severity Score Following Neurological Rehabilitation for a 43-year-old Female Patient with Post Concussive Syndrome and a Centrally Maintained Vestibulopathy



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 43-year-old female patient presented to Plasticity Brain Centers for evaluation and treatment of persistent symptoms following a concussion that occurred three months prior. Her symptoms included difficulty walking, changes in job performance, memory lapses, and confusion of left and right.

Findings: Upon intake, she reported on the graded symptom checklist (GSC) (Simon 2017) a symptom severity score of 124. During neurocognitive testing on the C3 Logix program, her Trails B time was 44.0 seconds and digit symbol matching score in one minute was 53. 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. The average stability score on intake was calculated as 78.35%.

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, the symptom severity score decreased to 29 (-76.61%). Trails B time decreased to 33.7 seconds (-23.41%). Digit symbol matching score representing processing speed was 68 (+22.06%). Stability scores improved, with the average stability score calculated as 86.80% (+10.78%).

Conclusion: The authors suggest further investigation into multi-modal, intensive approaches to decrease symptom severity and improve processing speed and balance in patients with Post Concussive Syndrome and a Centrally Maintained Vestibulopathy.

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 
  5. Neuropsychology (2017) Oct; 0: 1-14. Doi: 10.1080/87565641.2017.1383994. Epub 2017 Oct 25.

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