Neurocognitive measures and self-reported symptoms following a short intensive multimodal neurorehabilitation program in individuals with post-concussion syndrome: Retrospective case-series study

Abstract

This case-series study investigates the effect of a condensed multi-modal neurorehabilitation program on neurocognitive measures and self-reported symptoms using the C3Logix assessment tool on 137 individuals with diagnosed Post-Concussion Syndrome (PCS). In PCS, neurocognitive dysfunction is typically accompanied by symptoms of the physical, affective, and sleep domains. While most individuals recover within weeks of sustaining a head injury, evidence shows that those who do not recover in 3 months, may never. Recovery methods are usually prescribed with varying success, but the pathophysiologic complexity of concussion may require additional rehabilitation strategies that address the impaired neural networks to accelerate recovery. 137 individuals (M: 81, F: 56; mean (SD) age: 32.0 (14.0)) with a diagnosed PCS were treated at an outpatient rehabilitation center specializing in functional neurology. Using the C3Logix platform, individuals were evaluated at the intake and discharge of a 5-day program. Interventions included neuromuscular re-education, vestibular rehabilitation, orthoptics and cognitive training. Neurocognitive components and symptoms were exported and analyzed in Graphpad PRISM v. 8.4.3 using an rmANOVA. Results are reported as difference-of-means (95% CI). An alpha level of 0.05 was considered statistically significant. The C3Logix modified Graded Symptom Checklist score (0-150) decreased by 19.45 (15.16-23.75) (p < 0.0001), Trails A and B decreased 3.9 s (2.2-5.5) and 4.8 s (2.1-7.5) (p < 0.0001), respectively. Simple- and Choice Reaction Time decreased 31.3 ms (21.5-41.1) and 50.7 ms (37.9-63.6) (p < 0.0001), respectively. Static and Dynamic Visual Acuity decreased 0.03 LogMAR (0.0085-0.059) (p = 0.0021) and 0.05 LogMAR (0.021-0.073), respectively. Standardized Assessment of Concussion score (0-30) increased 0.8 (0.3-1.3) (p = 0.001) and digit-symbol coding increased 4.6 symbols (3.0-6.2) (p < 0.0001). The results of the present case-series study suggest clinically relevant improvements in neurocognitive measures and subjective symptoms in individuals with PCS following a multi-modal 5-day rehabilitation program.