Utilization of Dynamic Posturography in a Multimodal Treatment Approach in a Patient with Mild Traumatic Brain Injury
Presentation: A 16 year old high school hockey player presented with headaches and dizziness following a prior mild traumatic brain injury while playing hockey. The patient was evaluated diagnostically by the use of dynamic posturography. Dynamic posturography is a non-invasive specialized clinical assessment that quantifies how well the patient is able to maintain balance and posture. The assessment includes balance tests on perturbed and non-perturbed surfaces, eyes open and eyes closed testing, and testing in different head positions.
Methods: The patient was treated over a four day span that included 3 treatment sessions per day. Each treatment session lasted one hour. Each treatment session included repetitive peripheral somatosensory stimulation, gaze stability exercises, neuromuscular reeducation techniques, and breathing exercises.
Results: On intake posturography, the patient’s stability score was 62.7% on a perturbed surface with his eyes closed and head turned to the right. On a perturbed surface with his eyes closed and head flexed, the patient scored 53.8%. After 4 days of treatment, the patient scored 81.6% and 76.5 on those assessments, respectively.
Conclusion: The rapid improvement of dynamic postural control demonstrate a statistically significant patient outcome. The control of balance and posture is mediated by the integration of sensory information provided by the visual, vestibular, and proprioceptive systems that result in motor output commands. These findings suggest that the intensive neurological treatment approach utilized in this case and the diagnostic data provided by dynamic posturography are important clinical aspects in neurological rehabilitation.
Acknowledgments: The authors would like to thank Dr. Frederick Carrick and the Carrick Institute of Graduate Studies for the training and clinical neuroscience.
The authors would like to also thank Dr. Marc Ellis for the temporary utilization of his facilities for which this patient was seen and treated.
The authors would also like to thank Dr. Kelsey Brenner, Dr. Stuart Rutledge, Dr. Lon Kalapp, Dr. Eduardo Fontana, Dr. Ben Behrendt, and Matthew Leonard for their assistance in patient treatment.