Improvements in Processing Speed, Stability Score, and a Decrease in Symptom Severity Score Following Neurological Rehabilitation for a 43-year-old Female Patient with Post Concussive Syndrome and a Centrally Maintained Vestibulopathy

Presentation: A 43-year-old female patient presented to Plasticity Brain Centers for evaluation and treatment of persistent symptoms following a concussion that occurred three months prior. Her symptoms included difficulty walking, changes in job performance, memory lapses, and confusion of left and right.

Findings: Upon intake, she reported on the graded symptom checklist (GSC) (Simon 2017) a symptom severity score of 124. During neurocognitive testing on the C3 Logix program, her Trails B time was 44.0 seconds and digit symbol matching score in one minute was 53. 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. The average stability score on intake was calculated as 78.35%.

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, the symptom severity score decreased to 29 (-76.61%). Trails B time decreased to 33.7 seconds (-23.41%). Digit symbol matching score representing processing speed was 68 (+22.06%). Stability scores improved, with the average stability score calculated as 86.80% (+10.78%).

Conclusion: The authors suggest further investigation into multi-modal, intensive approaches to decrease symptom severity and improve processing speed and balance in patients with Post Concussive Syndrome and a Centrally Maintained Vestibulopathy.

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