Improvements in Processing Speed, King Devick Test Time, Fluid Cognitive Abilities, Stability Scores and a Decrease in Symptom Severity Scores Following Neurological Rehabilitation for a 53-year-old Female Patient with Post-Concussive Syndrome with Centrally Maintained Vestibulopathy

Emily R. Kalambaheti1*, Matthew M. Antonucci1, 2, Michael Greenwell1 and Mia Cozart3

1Plasticity Brain Centers, United States

2Carrick Institute, United States

3University of Central Florida, United States

Presentation: A 53-year-old female patient presented to Plasticity Brain Centers for evaluation and treatment of Post-Concussive Syndrome (PCS) with Centrally Maintained Vestibulopathy (CMV). Her symptoms included oculomotor dysfunction, issues with focus and processing, and brain fog.

Findings: Upon intake, with neurocognitive testing on the C3 Logix program, her Trails A time was 58.6 seconds (50th percentile being 24.4 seconds) and her Trails B time was 103.2 seconds (50th percentile being 47.1 seconds). Her digit symbol matching score was 41 correct in 120 seconds (50th percentile being 56). 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. Her overall average stability score was 44.43%. She reported on the graded symptom checklist (GSC) (Simon 2017) a symptom severity score of 61. She completed the King Devick three-card baseline test in 222.5 seconds.

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, Trails A time decreased to 25.6 seconds (-56.31%) and her Trails B time was 47.4 seconds (-54.07%). Digit symbol matching score representing processing speed was 56 correct in 120 seconds (+36.59%). Stability scores improved, with the average stability score calculated as 80.93% (+82.11%). Her symptom severity score decreased to 12 (-80.33%). She completed the King Devick three-card baseline test in 106.0 seconds (-52.36%).

Conclusion: The authors suggest further investigation into multi-modal, intensive approaches to improve processing speed, King Devick test time, fluid cognitive abilities (Salthouse 2011), stability scores and decrease symptom severity scores in patients with PCS with CMV.


  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 Neuropsychology (2017) Oct; 0: 1-14. Doi: 10.1080/87565641.2017.1383994. Epub 2017 Oct 25.
  5. Salthouse T. What Cognitive Abilities are Involved in Trail-Making Performance?
    2011 July-August; 39(4): 222–232.

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