Multimodal Neurological Approach to a Professional Athlete with Anxiety and Post-Concussive Syndrome
Background: A 24 year old professional hockey player presented with anxiety, difficulty concentrating, and balance issues. He had sustained two previous head injuries while playing hockey.
Examination: The patient presented with a pathological left ocular tilt reaction. The patient’s seated heart rate was 55 beats per minute (BPM) and increased to 94 BPM after standing. The patient had a 4:1 V:A ratio on the right side, as well as red desaturation on the right side that improved after light stimulation. During balance testing, on a perturbed surface with his head turned to the left, the patient had a 45% stability score and fell in 7 seconds. Upward vertical pursuit following was saccadic during the entire stimulation at all speeds.
Results: The patient was treated over a four day span that included gaze stability exercises, eye movement therapy, chair rotations, and the interactive metronome. The patient had a 3:2 V:A ratio after treatment and did not have red desaturation. His stability score on foam with his head turned to the left improved to 75.7%. Vertical upward pursuit movements were vastly improved with no saccadic intrusions at .1 Hertz (Hz) and .2 Hz. His subjective anxiety decreased from 3/6 to 1/6.
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 anxiety. These results promote the need for further research.
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.