Improvements in Stability Scores, Cognition, and Reduced Symptom Severity Score Following Neurological Rehabilitation for a 35-year-old Female Professional Skier with Post-Concussive Syndrome

Presentation: A 35-year-old female professional skier presented to Plasticity Brain Centers for evaluation and treatment of post-concussive syndrome (PCS) following sport related injuries. She reported that she was no longer able to ski, and that her symptoms included headache, earache, nausea, dizziness, and fatigue.

Findings: When asked to rate her symptoms on a graded symptom checklist (GSC) (Simon 2017), she reported a score of 65. Her Trails A time was 22.7 seconds (50th percentile equals 24.4 seconds). On the standardized assessment of concussion, she scored 26 out of 30. 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 different positions. Her average stability score was 79.925%.

Methods: A 8-day, multi-modal program of neurological exercises was administered in 18 one-hour treatment sessions (Carrick 2017) that consisted of repetitive peripheral somatosensory stimuli, neuromuscular reeducation exercises, vestibular rehabilitation exercises, orthoptic exercises, cognitive exercises, and off-vertical axis rotation (Gdowski 1999) utilizing a multi-axis rotational chair (MARC).

Outcome: Upon exit, the symptom severity score decreased to 23 (-64.6154%). Her Trails A time (Salthouse 2011) decreased to 11.1 seconds (-51.1013%). The standardized assessment of concussion score increased to 29 (+10.3448%). Her average stability score increased to 85.987% (+7.58%)

Conclusion: The authors suggest further investigation into multi-modal, intensive approaches to decrease symptom severity, improve cognition, and improve stability scores in patients with PCS.

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