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Improvement in Processing Speed, Fluid Cognitive Ability, Saccadometry, Stability Scores and Decrease in Symptom Severity Scores Following Neurological Rehabilitation for a 22-year-old Male Patient with Post Concussive Syndrome



Matthew M. Antonucci1, Paul E. Link1, Michael Greenwell1 and Derek A. Barton1*

1Plasticity Brain Centers, United States

Presentation: A 22-year-old male patient presented to Plasticity Brain Centers for evaluation and treatment of persistent symptoms of post concussive syndrome (PCS) following a traumatic brain injury that occurred seven months prior. His symptoms included headaches, sleeping difficulties, and fatigue.

Findings: During neurocognitive testing on the C3 Logix program, upon intake, his Trials-making test time for Trails B was 68.0 seconds. His digit symbol matching score was 54 in 120 seconds (50th percentile being 59). 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. His overall average stability score on intake was 75.31%. When testing eye saccades on a saccadometer he produced a score of 55 correct eye movements and 13 incorrect eye movements. He reported a symptom severity score of 15 on the graded symptom checklist (GSC) (Simon 2017).

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 re-education exercises, vestibular rehabilitation exercises, orthoptic exercises, and off-vertical axis rotation (Gdowski 1999) utilizing a multi-axis rotational chair (MARC).

Outcome: Upon exit, Trails B time decreased to 53.3 seconds (-21.62%) (50th percentile equals 42.46 seconds). Digit symbol matching score representing processing speed was 61 in 120 seconds (+11.48%). Stability scores improved, with the average stability score calculated as 84.61% (+11.00%). After doing a final saccadometer test he produced a score of 99 correct movements with 0 incorrect movements (+80.00% in correct eye movements and was able to complete without any incorrect eye movements). When re-tested on the graded symptom checklist, his symptom severity score decreased to 8 (-46.67%).

Conclusion: The authors suggest further investigation into multi-modal, intensive approaches to decrease symptom severity and improve processing speed, fluid cognitive abilities, saccadometry, stability scores and decrease in symptom severity scores in patients with PCS.

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
  4. Simon M, Maerlender A, Metzger K, Decoster L, Hollingworth A, McLeod TV. Reliability and Concurrent Validity of Select C3 Logix Test Components. Developmental Neuropsychology (2017) Oct; 0: 1-14. Doi: 10.1080/87565641.2017.1383994. Epub 2017 Oct 25.
  5. Salthouse T. What Cognitive Abilities are Involved in Trail-Making Performance? Intelligence. 2011 July-August; 39(4): 222–232.

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