1Plasticity Brain Centers, United States
Presentation: A 22-year-old male patient presented to Plasticity Brain Centers for evaluation and treatment of persistent symptoms of post concussive syndrome (PCS) following a traumatic brain injury that occurred seven months prior. His symptoms included headaches, sleeping difficulties, and fatigue.
Findings: During neurocognitive testing on the C3 Logix program, upon intake, his Trials-making test time for Trails B was 68.0 seconds. His digit symbol matching score was 54 in 120 seconds (50th percentile being 59). 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. His overall average stability score on intake was 75.31%. When testing eye saccades on a saccadometer he produced a score of 55 correct eye movements and 13 incorrect eye movements. He reported a symptom severity score of 15 on the graded symptom checklist (GSC) (Simon 2017).
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 re-education exercises, vestibular rehabilitation exercises, orthoptic exercises, and off-vertical axis rotation (Gdowski 1999) utilizing a multi-axis rotational chair (MARC).
Outcome: Upon exit, Trails B time decreased to 53.3 seconds (-21.62%) (50th percentile equals 42.46 seconds). Digit symbol matching score representing processing speed was 61 in 120 seconds (+11.48%). Stability scores improved, with the average stability score calculated as 84.61% (+11.00%). After doing a final saccadometer test he produced a score of 99 correct movements with 0 incorrect movements (+80.00% in correct eye movements and was able to complete without any incorrect eye movements). When re-tested on the graded symptom checklist, his symptom severity score decreased to 8 (-46.67%).
Conclusion: The authors suggest further investigation into multi-modal, intensive approaches to decrease symptom severity and improve processing speed, fluid cognitive abilities, saccadometry, stability scores and decrease in symptom severity scores in patients with PCS.