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Improvements in Dynamic Visual Acuity, Simple and Choice Reaction Times, Center of Pressure and Optokinetic Response Following Neurological Rehabilitation for a 33-year-old Male Patient with a Traumatic Brain Injury



Matthew M. Antonucci1, Emily Kalambaheti1, Mia Cozart1, Paul E. Link1 andDerek A. Barton1*

1Plasticity Brain Centers, United States

Presentation: A 33-year-old male patient presented to Plasticity Brain Centers for evaluation and treatment of persistent symptoms of a traumatic brain injury that occurred six years prior. His symptoms included slurred speech, impaired cognition, and slow movements.

Findings: During neurocognitive testing on the C3 Logix program, upon intake, his simple reaction time was 329 milliseconds and his choice reaction time was 468 milliseconds. He lost 1.2 lines from static to dynamic visual acuity. 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 center of pressure upon intake measured at 1.02 inches backwards and 0.32 inches to the left.

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

Outcome: Upon exit, simple reaction time decreased to 305 milliseconds (-7.29%) and his choice reaction time was 468 milliseconds (-12.36%). Visual acuity improved losing only 0.6 lines from static to dynamic (-70.00%). Normalization of center of pressure was obtained with scores improving to 0.47 inches backwards (+53.92%) and 0.22 inches to the left (+40.54%) creating a more normalized center of pressure. Upon exit, the patient showed improvements in optokinetic response by following a more consistent pattern.

Conclusion: The authors suggest further investigation into multi-modal, intensive approaches to improve dynamic visual acuity, simple and choice reaction times, center of pressure, and optokinetic response in patients with traumatic brain injuries.

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 
  5. Neuropsychology (2017) Oct; 0: 1-14. Doi: 10.1080/87565641.2017.1383994. Epub 2017 Oct 25. 
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