Background: A 52-year-old female with cognitive deficits presented for treatment. She had a history of two previous concussions.
Methodology: The patient was unable to perform short term memory tests, orientation questions, coding/digit-symbol matching, and Trail-making tests. The patient’s blood pressure on the left dropped 31 mmHg upon rising from a lying to a standing position. The patient had spontaneous square wave jerk eye movements and a left eye eso-deviation while in darkness. During left gaze holding, the patient had multiple large intrusions to the right. The patient had saccadic upward pursuit movements with no slow phase movement. The patient had multistep saccades in all directions. The patient had good balance scores in with eyes open, eyes closed, and on a perturbed surface with eyes open and closed and with head turns. The patient had a deficient left vestibulo-ocular reflex and no vertical vestibulo-ocular reflex. The patient also had a faulty convergence/divergence mechanism, in which the left eye did not accommodate nor diverge upon a given stimulus. The patient also had many spontaneous eye movements while performing finger-to-nose tasks. Left finger tap test revealed four hesitations and dysmetria of targeting.
Intervention: Tilt table therapy (5º incremented inclines with therapy at each angle) was utilized with non-invasive nerve stimulation (NINS) of the tongue. The right median nerve was also stimulated via NINS. Gaze fixation training involving sinusoidal oscillatory yaw (no-no) head movement and sinusoidal oscillatory pitch (yes-yes) head movements were utilized; no-no head movements with 5 vertical dots, and yes-yes head movements with one central dot. Yes-yes head movements were performed immediately after a 10 second left optokinetic stimulation. Carrick Eye Exercises consisting of right upward microsaccades and left downward pursuit following was performed. Bead sting exercises (targeting at different depths) were used to train convergence and divergence. The patient also performed mental tasks while doing upper and lower extremity neuromuscular re-education procedures consisting of figure-of-eight movements.
Outcome: The patient’s saccadic accuracy significantly changed with only one small refixation saccade occurring in both lateral directions (60% accuracy to 96% accuracy). Integrity of the patient's VOR restored, and full in all directions at the end of the week. Convergence and divergence targeting was significantly improved; only slight slowness of the divergence of the left eye persisted. The patient was able to successfully count backwards with numbers, say the months of the year and days of the week with minimal lapses (1 or 2), say the alphabet without lapses, and dual-task (say a number or day of the week and think the next, then say the next one). The patient’s orthostatic hypotension also decreased when changing from a lying to a standing position. The patient was able to perform digit-symbol matching and trails making A tests at the end of the week. The patient was able to perform hand-eye coordination exercises without lapses in performance and without spontaneous eye movements
Keywords: cognitive decline, Vestibular Rehabilitation, carrick eye exercises, concussion, orthostatic hypotension
Conference: International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function, Orlando, United States, 7 Oct - 9 Oct, 2016.
Presentation Type: Poster Presentation Topic: Abstracts ISCN 2016
Citation: Antonucci MM, Barton DA, Link PE and Carrick FR (2016). Cognitive improvement in a 52-year-old female with cognitive decline following a 5-day ReceptorBased treatment.. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function. doi: 10.3389/conf.fneur.2016.59.00036
Received: 31 Aug 2016; Published Online: 07 Sep 2016.