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A Case study on neurological rehabilitation for a 16 year old female patient with Post Concussive Syndrome, Dysautonomia and Postural Orthostatic Tachycardia Syndrome (POTS).



Paul E. Link1*, Emily Kalambaheti1, Megan Manno1 and Matthew M. Antonucci1

1Plasticity Brain Centers, United States

Presentation: A 16-year-old female patient presented to Plasticity Brain Centers for evaluation and treatment of Post Concussive Syndrome and Dysautonomia with the following symptomatology:

Findings: Upon intake she had a mitral valve murmur, 3:1 vein: artery bilaterally, bilateral exophoria, decreased extensor strength in the upper and lower extremities on the left, decreased gain in vestibular-ocular response (VOR) rightward, and a left convergence failure. 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 multiple positions. The average stability score was 78.918%, with 69.48% with head right on the foamed surface, and 68.96% with head flexed on the foamed surface.

Methods: A 5-day, multi-modal program of neurological exercises was administered in 10 one-hour treatment sessions. Each session consisted of electrical somatosensory stimulation, neuromuscular reeducation exercises, vestibular rehabilitation exercises, eye exercises, and off-vertical axis rotation:

Outcome: Upon exit examination, the patient had equal and appropriate convergence/divergence, equal extensor strength bilaterally in the upper and lower extremities, and absence of the mitral valve murmur. Stability scores improved, with the average stability score of 82.722%, with a stability of 77.11% in the head right position on the foamed surface and 79.23% in flexion on the foamed surface.

Conclusion: The authors suggest further investigation into multi-modal, intensive approaches to decrease symptom severity and improve saccades and balance in patients with Post Concussive Syndrome and Dysautonomia.

References:

  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

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