Improvements in Cognition, Graded Symptom Checklist Score, Balance and Memory Following Neurological Rehabilitation for a 58-year-old Male Patient with Post-Concussion Syndrome: Case Report

Abstract

To suggest the efficacy of multi-modal, intensive, neurologic rehabilitation approaches to improve cognition, balance, and cognitive impairment in patients with post-concussion syndrome. A 58-year-old male patient presented to Plasticity Brain Centers for evaluation and treatment of persistent symptoms following a previously diagnosed concussion. His symptoms followed rapidly after injury and included headaches, neck pain, and difficulty with sleeping. Upon intake, he reported on the graded symptom checklist (GSC) a symptom severity score of 59. 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 upon intake was calculated as 53.9% overall. Neurocognitive testing utilizing C3 Logix Neurocognitive Assessment Suite, Trails A time was 28.6 and standardized assessment of cognition (SAC) score was a 28/30 with specific difficulty in delayed memory. A 5-day, intensive, multi-modal program of neurologic exercises was administered in 10 one-hour treatment sessions. Each session consisted of repetitive peripheral somatosensory stimuli, cognitive exercises, neuromuscular reeducation, vestibular rehabilitation, orthoptic exercises, and off-vertical axis rotation utilizing a multi-axis rotational chair. Upon exit, symptom severity score decreased to 35 (-40.6%); Trails A time decreased to 19.7 (-31.1%); balance improved from an average stability score of 75.5%-79.6% (+5.4%); and standardized assessment of cognition (SAC) score increased to an overall score of 30/10 (+7.1%) with an improvement in delayed memory. The authors suggest further investigation into multi-modal, intensive approaches to improve cognition, balance, and cognitive impairment in patients with post-concussion syndrome.