Presentation: A 16-year-old female patient presented to Plasticity Brain Centers for evaluation and treatment of Post Concussive Syndrome and Dysautonomia with the following symptomatology:
Findings: Upon intake she had a mitral valve murmur, 3:1 vein: artery bilaterally, bilateral exophoria, decreased extensor strength in the upper and lower extremities on the left, decreased gain in vestibular-ocular response (VOR) rightward, and a left convergence failure. A Comprehensive Assessment of Postural Systems (CAPS®) (Pagnacco 2014) was performed assessing balance and stability, on a solid and foamed surface, with eyes opened and closed with head in multiple positions. The average stability score was 78.918%, with 69.48% with head right on the foamed surface, and 68.96% with head flexed on the foamed surface.
Methods: A 5-day, multi-modal program of neurological exercises was administered in 10 one-hour treatment sessions. Each session consisted of electrical somatosensory stimulation, neuromuscular reeducation exercises, vestibular rehabilitation exercises, eye exercises, and off-vertical axis rotation:
Outcome: Upon exit examination, the patient had equal and appropriate convergence/divergence, equal extensor strength bilaterally in the upper and lower extremities, and absence of the mitral valve murmur. Stability scores improved, with the average stability score of 82.722%, with a stability of 77.11% in the head right position on the foamed surface and 79.23% in flexion on the foamed surface.
Conclusion: The authors suggest further investigation into multi-modal, intensive approaches to decrease symptom severity and improve saccades and balance in patients with Post Concussive Syndrome and Dysautonomia.