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Improvements in Stability Scores, Cognition, and Reduced Symptom Severity Score Following Neurological Rehabilitation for a 35-year-old Female Professional Skier with Post-Concussive Syndrome



Emily R. Kalambaheti1*, Megan Manno2 and Matthew M. Antonucci1, 3

1Plasticity Brain Centers, United States

2University of Central Florida, United States

3Carrick Institute, United States

Presentation: A 35-year-old female professional skier presented to Plasticity Brain Centers for evaluation and treatment of post-concussive syndrome (PCS) following sport related injuries. She reported that she was no longer able to ski, and that her symptoms included headache, earache, nausea, dizziness, and fatigue.

Findings: When asked to rate her symptoms on a graded symptom checklist (GSC) (Simon 2017), she reported a score of 65. Her Trails A time was 22.7 seconds (50th percentile equals 24.4 seconds). On the standardized assessment of concussion, she scored 26 out of 30. 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 different positions. Her average stability score was 79.925%.

Methods: A 8-day, multi-modal program of neurological exercises was administered in 18 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, the symptom severity score decreased to 23 (-64.6154%). Her Trails A time (Salthouse 2011) decreased to 11.1 seconds (-51.1013%). The standardized assessment of concussion score increased to 29 (+10.3448%). Her average stability score increased to 85.987% (+7.58%)

Conclusion: The authors suggest further investigation into multi-modal, intensive approaches to decrease symptom severity, improve cognition, and improve stability 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. 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  
  3. 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  
  4. 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  
  5. Salthouse T. What Cognitive Abilities are Involved in Trail-Making Performance? Intelligence. 2011 July-August; 39(4): 222–232.  
  6. 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.

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