Abstract
Abstract Purpose Limited research exists on treatment of sport concussion in visually impaired individuals. Adaptation to athlete’s needs is vital for individualized sport specific return to play (RTP). Methods Fifteen year-old, visually impaired, female, swimmer presented to an interdisciplinary Sport Concussion Program for protracted recovery with complaints of disequilibrium, headaches, cognitive fatigue, and exacerbation of premorbid resting nystagmus after being kicked in the head during practice. Patient is legally blind due to Peter’s Anomaly and right retinal detachment, with history of migraine, carsickness, and glaucoma. Patient completed two visits with clinical sports neuropsychologist and three vestibular therapy (VT) appointments, assessed via Post-Concussion Symptom Scale (PCSS), Montreal Cognitive Assessment (MoCA-BLIND), Modified Balance Error Scoring System (mBESS), Dizziness Handicap Inventory (DHI), Activities-Specific Balance Confidence scale (ABC), Buffalo Concussion Treadmill Test (BCTT), and Children's Memory Scales (CMS). Differential Diagnosis: Concussion, Post-Concussion Syndrome, Post-Traumatic Headache, Vestibular Dysfunction. Results Initial consult revealed PCSS of 35 and normal MoCA-BLIND (18/22). Patient’s mBESS improved from 7 to 3 errors with VT, DHI mildly elevated (36%), ABC moderately elevated (43%). VT consisted of: neuromuscular re-education, balance training, positional changes, cognitive activity, sport specific RTP progressions (dry land modifications, transitions into water, communication to team athletic trainer). BCTT passed on third VT visit. Patient cleared for RTP with PCSS at 7 and (CMS) Stories, Word Lists, Numbers, and Sequences subtests within expectations (average to high average ranges). Conclusion This case study illustrates an interdisciplinary approach to concussion treatment with modification of established tools and proposal of sport specific RTP guidelines for visually impaired athletes.
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