Autonomic, Tactile, Symptom, and Cognitive Improvements in a Male Quadriplegic Spinal Cord Injury after Near-Drowning Incident
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1
Carrick Institute, United States
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2
Plasticity Brain Centers, United States
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3
Accelerate Multidisciplinary Neuroscience Research Center, College of Medicine, University of Central Florida, United States
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4
University of Central Florida College of Medicine, United States
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5
MGH Institute of Health Professions, United States
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6
Bedfordshire Centre for Mental Health Research, University of Cambridge, United Kingdom
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7
University of Central Florida, United States
Background: Spinal cord injuries (SCI) have been found to be associated with autonomic, sensory, motor, and cognitive impairment (Sachdeva 2018). The subject of this report, a 29-year-old male patient, presented to Plasticity Brain Centers for evaluation and treatment of symptoms of a diving-related accident 2 years prior in which the fractured 3 cervical vertebrae, lost consciousness, and was without oxygen for approximately 6-8 minutes prior to being resuscitated. This incident resulted in (partially resolved) quadriplegia, urinary incontinence, anesthesia, and cognitive dysfunction. Medical history and imaging confirmed a C4-C6 spinal cord injury.
Findings: At the time of examination, the patient’s was completely anesthetic to pain, temperature, vibration, and touch below the T1 dermatome. He was unable to voluntarily control his bladder function. Graded Symptom Checklist (GSC) (Simon 2017) symptom severity score was 35. Neurocognitive assessment utilizing C3 Logix was performed. Trail Making Test (TMT) was performed with his dominant (better-functioning) hand. His TMT-A and TMT-B scores were 50.2 seconds and 63.2 seconds; digit symbol matching score in two minutes was 65; standardized assessment of concussion (SAC) upon intake was scored 25 out of a possible 30 points with specific difficulty in the reverse-digit span with a score of 2 out of a possible 5.
Methods: Two contiguous intensive rehabilitation weeks separated by 2 non-treatment days, were performed. Each week consisted of 11 one-hour sessions over 5 days, for a total of 22 multi-modal neurological rehabilitation similar to the methodology of Carrick 2017. Each session consisted of repetitive peripheral somatosensory stimuli, neuromuscular reeducation exercises, vestibular rehabilitation exercises, orthoptic exercises, and off-vertical axis rotation utilizing a multi-axis rotational chair (MARC, ReNeuro Robotics, Dallas, TX, USA).
Outcome: Upon exit, the symptom severity score decreased to 7 (-80.00%); TMT-A decreased to 40.8 (-18.72%) and TMT-B to 49.9 seconds (-21.04%). Digit symbol matching score speed was 59 (+5.36%). SAC scores improved with an overall score of 27/30 (+8.00%) and a resolution of reverse-digit span with a score of 5 out of a possible 5 (+150.00%). The patient stated that he was beginning to have the urge to urinate. He had pain, tactile, vibratory, (but no temperature sensation) down to the L2 dermatome on his left side, and to T12 dermatome on his right side.
Conclusion: This report demonstrates the results of a two-week intensive, multi-modal neurorehabilitation program in a male with a traumatically induced SCI with cognitive impairment. Multi-modal, intensive neurorehabilitation may be effective at decreasing symptom severity scores and increase cognitive ability in patients with chronic spinal cord injuries.
Acknowledgements
We would like to thank the clinical and administrative team at Plasticity Brain Centers for supporting this patient in their care.
References
Carrick FR, Clark JF, Pagnacco G, Antonucci MM, Hankir A, Zaman R, and Oggero E (2017) Head–Eye Vestibular Motion Therapy Affects the Mental and Physical Health of Severe Chronic Postconcussion Patients. Front. Neurol. 8:414. doi: 10.3389/fneur.2017.00414
Sachdeva, R., Gao, F., Chan, C. C. H., & Krassioukov, A. V. (2018). Cognitive function after spinal cord injury. Neurology, 10.1212/WNL.0000000000006244.doi:10.1212/wnl.0000000000006244
Simon M, Maerlender A, Metzger K, Decoster L, Hollingworth A, McLeod TV. Reliability and Concurrent Validity of Select C3 Logix Test Components. Developmental Neuropsychology (2017) Oct; 0: 1-14. Doi: 10.1080/87565641.2017.1383994. Epub 2017 Oct 25.
Keywords:
SCI Spinal cord injury,
cognitive impaiment,
Anoxia,
Quadriplegia,
Neurorehabiliation,
Intensive therapy program
Conference:
International Symposium on Clinical Neuroscience, Orlando, United States, 24 May - 26 May, 2019.
Presentation Type:
Poster Presentation
Topic:
Basic Science
Citation:
Antonucci
MM,
Carrick
FR,
Kalambaheti
E and
Cozart
M
(2019). Autonomic, Tactile, Symptom, and Cognitive Improvements in a Male Quadriplegic Spinal Cord Injury after Near-Drowning Incident.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience.
doi: 10.3389/conf.fneur.2019.62.00075
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Received:
18 May 2019;
Published Online:
27 Sep 2019.
*
Correspondence:
Dr. Matthew M Antonucci, Carrick Institute, Cape Canaveral, United States, drnucci@gmail.com