Improvements in Balance Stability Scores, Cognition, and 67% Reduced Symptom Severity Score Following Neurological Rehabilitation for a 37-year-old Female with Post-Concussive Syndrome

Abstract

Event Abstract Back to Event Improvements in Balance Stability Scores, Cognition, and 67% Reduced Symptom Severity Score Following Neurological Rehabilitation for a 37-year-old Female with Post-Concussive Syndrome Angela M. Gabella1, 2* 1 Carrick Institute, United States 2 Precision Brain Center, United States Presentation: A 37-year-old female patient presented to Precision Brain Center for evaluation and treatment of post-concussive syndrome (PCS). She presented with the following symptomatology: chronic dizziness, short-term memory loss, confusion, poor concentration, cognitive decline, severe anxiety, Irritability, full body tremors, feels like her insides are vibrating, vision problems, fatigue, brain fog, weakness in her right arm and hand, and bilateral swelling in her legs. Her symptom first started 2 years ago with insidious onset then in 2018 she got dizzy while working out and fell and hit her head on a dumbbell. After suffering a concussion her symptoms immediately worsen. Findings: A comprehensive neurological examination revealed a right ocular esotropia, left ocular hypertropia, corectasia of right pupil, a decreased perception of pinprick on right face when compared to the left, decreased palate elevation on the right. Anti-saccade test revealed multiple ocular pro-saccadic errors. Fundoscopic exam with occluded vision revealed up beating nystagmus with right square wave jerks. In accordance to the UPDRS guidelines finger tapping test was a grade 2 on the left, finger to nose test was grade 2 left with dysmetria, supination-pronation arm test was grade 2 on the left, gait test grade 2 left decrease arm swing, gait with dual tasking test was grade 3, abolished left arm swing & freezing. When asked to rate her symptoms on a Post-Concussion Symptoms Scale (PCSS) (SCAT5 2017), she reported a score of 104 (0-132 scale). On the standardized assessment of concussion (SAC), she scored 14 out of 30. An Assessment of the balance system using The Balance Error Scoring System (BESS) was performed assessing balance and stability, on a solid and foamed surface, with eyes closed, and in double leg, single leg, and in tandem stance. The BESS score was 22 (total errors) out of 60. Methods: A multi-modal program of neurological exercises was administered in 18 one-hour treatment sessions over a 9 week period. Each session consisted of various combinations of eye-head vestibular motion therapy, repetitive peripheral somatosensory stimuli, proprioception retraining, vestibular rehabilitation, cognitive training, and eye movement exercises. All exercises were precisely designed and modified to address the patient’s individual neurological deficits and physical exam findings were continually reassessed throughout treatment. Outcome: Upon exit, the symptom severity score (PCSS) decreased to 34 (-67.3%). Her SAC score increased to 26 out of 30 (85.7%). BESS balance scores improved to 10 (total errors) (-54.54%) out of 60. A 67% improvement in total symptom score was recorded after a multimodal neurological rehabilitation program was performed in 18 one-hour treatment sessions. Conclusion: The author suggests further investigation into multi-modal neurological exercises as a clinical approach to decrease symptom severity, improve SAC scores, and increase balance and stability scores in patients with PCS. Acknowledgements The authors would also like to thank the Carrick Institute for providing the clinical education utilized to develop the multi-modal treatments implemented in this case study.