Brazilian Jiu-Jitsu–Related Post-Concussion Symptoms Ameliorated With Neurorehabilitation

Abstract

Discuss neurorehabilitation efficacy in a case of concussion without direct head impact. While there is growing concern about the prevalence and severity of concussion in mixed martial arts, a grappling component, Brazilian Jiu-Jitsu, is not typically perceived as high risk. Rapid acceleration or deceleration without direct head trauma led to a concussion for a 15-year-old male during jiu-jitsu throwing drills. The subject and parents reported difficulty with academic performance, social interactions, and emotional regulation. Symptoms persisted for 4 months before care was sought by the subject and his parents. Without direct head trauma or impact, concussion was not initially suspected. Thirteen sessions of treatment were performed in a neurorehabilitation setting utilizing joint manipulation, vestibular rehabilitation with a whole-body off-axis rotation device, oculomotor exercises, neuromuscular re-education, and electrical stimulation. C3 Logix was utilized as a baseline (immediately preceding second treatment due to equipment difficulties) and at discharge to measure effects of treatment. Data is reported as "(baseline, discharge, percent-change)." Graded Symptom Checklist score out of 162 (91, 20; -78.02%), Trail Making Test A (sec) (26.8, 19.7; -26.49%), Trail Making Test B (sec) (69.9, 37.9; -45.78%), Digit-Symbol Matching speed (# of symbols) (66, 71; +7.58%), Choice reaction time (msec) (452, 397; -12.17), Static:Dynamic Visual Acuity (line difference) (1, 0.4; -60%). Subjectively, the subject and his parents reported improved academic performance, social interactions, and emotional regulation leading to a better home and educational experience for all involved. This case displays positive clinical improvements with a functional neurology approach to outpatient neurorehabilitation. Further investigation into this multimodal rehabilitation for post-concussion symptoms, with and without direct head impact, is recommended. Continued concussion education and awareness are recommended for sports with rapid acceleration or deceleration and limited direct head impact.