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

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.

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