Event Abstract Back to Event Egocentric vertigo symptoms diminished by multi-modal neurorehabilitation treatment Susan E. Esposito1* and Michael Pendleton2 1 Life University, United States 2 Southwest Brain Performance Center (SBPC), United States Presentation: A 64-year-old retired male presented to a chiropractic functional neurology clinic with a chief complaint of egocentric vertigo and constant lightheadedness, which began a year and a half prior of unknown etiology. He further described his symptoms by stating that his brain felt like “jelly” and that “it's like the hemispheres are separated and not fixed in my skull. He complained of double vision and that when he moved his head or walked, his vision “bounced”. He experienced symptoms walking up the stairs, but not down. He had been experiencing tinnitus in the right ear for the past six months. When the symptoms initiated, his neurologist had diagnosed him with benign paroxysmal positional vertigo (BPPV) and he was told by his physical therapist that he had vestibular neuritis in his right ear. He received treatment at that time consisting of a few Epley maneuvers and was given at-home Brandt-Daroff exercises, providing no relief of symptoms. Findings: Neurological examination produced the following positive results: inability to fixate on a target in the left field of vision, saccades in the downward direction had increased latency and were dysmetric, anti-saccade testing showed a 50% failure in the horizontal and 40% failure in the vertical direction, cover/uncover testing revealed a right hypertropia, and a refixation saccade was evidenced on head thrust testing in right yaw and right translation. Frenzyl goggle testing revealed a left convergence spasm and a 0.2 Hz left beating nystagmus, Dix-Hallpike was positive for a right horizontal canalithiasis. His dizziness handicap inventory (DHI) assessment was scored functional 22%, physical 20% and emotional 12%. (0% is minimum and 100% is maximum score in each category). C3 Logix graded symptoms of concussion questionnaire scored a symptom count of 26 out of a possible 27 and a 93 out of 162 for symptom severity. Computerized assessment of postural systems (CAPS) testing showed 0% stability (failure) on a perturbed surface with eyes closed, head in neutral (PSEC-HN) and a 41% stability on a perturbed surface with eyes closed, head in extension (PSEC-HE). Methods: The patient received treatment for 5 days over a two-week period. Each day of treatment consisted of 3 sessions of multi-modal functional neurorehabilitation treatment strategies. Treatments performed included combinations of the following therapies subject to daily modifications according to patient response. Transcortical vestibular stimulation using High Volt Galvanic at 3-8 microampere's (positive lead on the left mastoid and negative lead on the right mastoid) for 25 minutes. Right horizontal BBQ role. Head-Eye Movement therapy/gaze stabilization in the horizontal plane. Cerebellar exercises were performed by passive complex movements in the form of infinity signs with the upper right extremity. Small amplitude rightward rVOR Halmagyi head thrusts. Starting with slow velocity and working up to faster velocity. Leftward horizontal OPK stimulation for one pass. Brock beaded string exercises with the closest target at 8" and the rest spaced out to 60" for a total of six targets for vergence rehabilitation. Vibration plate therapy. Vestibulo-ocular reflex cancellation with 180 degree rotations to the right and 90-degree rotation to the left. The amplitude and number of rotations increased as the patient subjectively improved. Neurosensory integration on the ProactiveTM setting of 50 stimuli overloaded down to the left. Low level laser therapy was applied to increase Interleukin 10 (anti-inflammatory hormone), increase ATP production from the mitochondria, to increase blood flow, reduce inflammation and coordination of the involved areas. The therapy was performed for approximately 5 minutes using a trans-cortical stimulation of bilateral coronal hippocampus. Left brain eye exercises utilizing Focus BuilderTM on an iPad using right/upward diagonal microsaccades immediately followed by left/lower diagonal smooth pursuits. Outcome: After the initial day of treatment, the patient’s DHI assessment score decreased to functional 8%, physical 14% and emotional 6% and the patient claimed that he felt 10-20% better, slept better and the tinnitus had diminished. At the end of the 5 days of treatment, he claimed that his vertigo and lightheadedness had continued to improve, but was not completely resolved. Head thrust testing showed improvement on maintaining fixation, C3 Logix graded symptoms of concussion questionnaire decreased to 10/27 for symptom count and 26/162 for symptom severity. CAPS testing showed improved stability from 0% to 84% on PSEC-HN and from 41% to 63% PSEC-HE. Conclusion: This patient case evidenced that a multi-modal approach of functional neurorehabilitation was effective in diminishing egocentric vertigo and other neurologically related symptoms. Further research into neurorehabilitation in patients with these complaints is therefore warranted. Keywords: egocentric vertigo, Vertigo, Neurorehabilitation, chiropractic neurology, lightheadedness Conference: International Symposium on Clinical Neuroscience, Orlando, United States, 24 May - 26 May, 2019. Presentation Type: Poster Presentation Topic: Clinical Neuroscience Citation: Esposito SE and Pendleton M (2019). Egocentric vertigo symptoms diminished by multi-modal neurorehabilitation treatment. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience. doi: 10.3389/conf.fneur.2019.62.00002 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 31 Mar 2019; Published Online: 27 Sep 2019. * Correspondence: Mx. Susan E Esposito, Life University, Marietta, United States, susanesposito@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Susan E Esposito Michael Pendleton Google Susan E Esposito Michael Pendleton Google Scholar Susan E Esposito Michael Pendleton PubMed Susan E Esposito Michael Pendleton Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.