A Case study on neurological rehabilitation for a 16 year old female patient with Post Concussive Syndrome, Dysautonomia and Postural Orthostatic Tachycardia Syndrome (POTS).

Paul E. Link1*, Emily Kalambaheti1, Megan Manno1 and Matthew M. Antonucci1

1Plasticity Brain Centers, United States

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.


  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

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