Improvements in Cognition and Balance Following Neurological Rehabilitation for a 17-year-old female hockey player with Post Concussive Syndrome

Abstract

Objective is to show improvements in cognition and balance following neurologic rehabilitation for patient with post-concussive syndrome (PCS). A 17-year-old, female, patient presented to Plasticity Brain Centers for evaluation and treatment of persistent symptoms following 3 diagnosed concussions. Her first concussion occurred via a motor vehicle collision and the two latter concussions were obtained while playing hockey. Her primary symptoms included headaches and vision issues, which she has been experiencing for over 3 years. Upon intake, she reported on the graded symptom checklist (GSC) a symptom severity score of 32. During neurocognitive testing on the C3Logix program, her Trails A time was 14.1 seconds; Trails B time was 32.6 seconds; digit symbol matching score (DSMS) was 56; simple reaction time (SRT) was 299 milliseconds and her choice reaction time (CRT) was 381 milliseconds. A Comprehensive Assessment of Postural Systems (CAPS®) was performed assessing balance and stability, on both a solid and foamed surface, with eyes opened, eyes closed, and multiple head positions. An average stability score was calculated as 39.2%. A 5-day intensive with multi-modal neurologic exercises was administered in ten one-hour treatment sessions. Each session consisted of repetitive peripheral somatosensory stimuli, cognitive exercises, neuromuscular reeducation exercises, balance exercises, vestibular rehabilitation exercises, orthoptic exercises, and off-vertical axis rotation utilizing a multi-axis rotational chair. Upon exit, the symptom severity score decreased to 5 (-80.0%); Trails A time decreased to 10.9 (-22.7%); Trails B time decreased to 25.3 seconds (-22.4%). DSMS representing processing speed increased to 59 (+5.4%). SRT improved with a time of 245 milliseconds (-18.1%); and CRT was 311 milliseconds (-18.4%). Stability scores improved, with the average stability score calculated as 83.2% (+112.4%). The authors suggest further investigation into multi-modal, intensive approaches to improve cognition and balance in patients with PCS.