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Improvements in Cognition Following Neurological Rehabilitation for a 58-year-old Female with Central Vestibulopathy



Matthew M. Antonucci1, Emily R. Kalambaheti1, Megan Manno1, Brittany Forrester1 and Derek A. Barton1*

1Plasticity Brain Centers, United States

Presentation: A 58-year-old female presented to Plasticity Brain Centers for evaluation and treatment of central vestibulopathy following dizziness and vertigo of idiopathic origin. Her symptoms included dizziness, pain in the jaw, lightheadedness, and balance problems.

Findings: During intake, her Trails A time was 45.9 seconds (50th percentile equals 24.4 seconds); Trails B time was 89.4 seconds (50th percentile equals 47.1). On the standardized assessment of concussion, she scored 27 out of 30. Her digit symbol matching score on the processing speed test was 44 in 120 seconds (50th percentile being 56). On the King Devick (Galleta 2015) (Olson 2017) 3-card baseline test, she received a score of 75.2 seconds.

Methods: A 5-day, multi-modal program of neurological exercises was administered in 10 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, her Trails A time (Salthouse 2011) decreased to 22.7 seconds (-50.5447%); Trails B time decreased to 54 seconds (-39.5973%). The standardized assessment of concussion score increased to 29/30 (+10.3448%). Her digit symbol matching score was 54 (+18.5185%). King Devick score decreased to 62.2 seconds (-17.2872%).

Conclusion: The authors suggest further investigation into multi-modal, intensive approaches to improve cognition and oculometrics in patients with central vestibulopathy.

References:

  1. Galetta KM, Liu M, Leong DF, Ventura RE, Galetta SL, Baleer LJ. (2015) The King-Devick test of rapid number naming for concussion detection: meta-analysis and systematic review of the literature. Concussion. (2015) doi: 102217/cnc.15.8
  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. Olson BL, Oberlander TJ, Weidauer L (2017) Test-Retest Reliability of the King-Devick Test in an Adolescent Population. J of Athletic Training. 2017;52(2):000–000. doi: 10.4085/1062-6050-52.2.12
  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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