ABSTRACT: IMPROVEMENT WITH POSTURAL ORTHOSTATIC TACHYCARDIA SYNDROME, HEADACHES AND LIGHT SENSITIVITY IN A PATIENT WITH POST CONCUSSION SYNDROME FOLLOWING A PROGRAM OF MULTIMODAL VESTIBULAR REHABILITATION AND SPINAL MANIPULATIVE THERAPY
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1
Brain, Spine & Sport, United States
Brain, Spine & Sport
Private Practice, Avon, CT, USA
Email: drschiller@comcast.net
Background: a 23 year old male presented to a private practice with protracted symptoms of concussion including headache and light sensitivity related to a mountain biking accident 10 months prior. There was no loss of consciousness. The injury included cervical acceleration deceleration syndrome where the patient described a “whipped neck.” The severity of light sensitivity symptoms caused the patient to wear sunglasses while driving and working at a computer and were rated 8.5 out of 10 by the patient. Headache symptoms were rated 8 out of 10 by the patient. The protracted symptoms were consistent with Post Concussion Syndrome (PCS).
Methods: Neurological examination revealed head titubation and blepharoclonus in Romberg’s position, positive Fakuda’s to the right, optokinetic nystagmus (OPK) was abnormal to the right, pupillary reaction to light was abnormal with brisk reaction bilaterally and facial muscle activation on the right. Heart rate increased 30 beats per minute from supine to standing revealing postural orthostatic tachycardia syndrome (POTS). Saccodometry testing of 100 saccades revealed dysmetria with hypermetria to the right. Computerized Dynamic Posturography (CDP) revealed a posterior center of pressure (CoP), decreased postural stability with the head rotated to the right and a fall with head in extension. Palpation of the cervical and thoracic spine revealed several levels of segmental dysfunction/segmental dystonia. A program of multimodal vestibular rehabilitation (VR) and spinal manipulative therapy (SMT) was initiated to address the neurological findings. Multimodal VR included gaze-holding exercises in various positions and motions, passive and active vestibular canal stimulation, and eye movement exercises including: combinations of pursuits and saccades and eye movement exercises while at various angles on a tilt table.
Results: Patient reported improvement in the light sensitivity with a rating of 8.5 out of 10 reduced to a 2 out of 10. Patient reported improvement of headaches with a rating of 8 out of 10 reduced to a 1 out of 10. POTS signs resolved with persisting signs of dysautonomia. Titubation and blepharoclonus resolved, OPK testing normalized, gaze holding improved, and findings with pupillary reaction to light resolved. Patterns of hypermetria during saccodometry testing improved. Abnormal findings during CDP testing improved with normalization of CoP and the abnormal stability patterns during various head positions improved.
Conclusion: this author recommends further investigation into the treatment of POTS,
headaches and light sensitivity associated with PCS and CADS with multimodal VR and SMT.
Keywords:
Post concussion syndrome,
post concussion symptoms,
light sensitivity,
Headaches,
Postural Orthostatic Tachycardia Syndrome,
dysautonomia,
Saccades,
saccodometry,
computerized dynamic posturography,
Balance control,
spinal manipulation,
segmental dystonia,
Segmental dysfunction,
Chiropractic manipulation,
Center of Pressure (COP),
Vestibular Rehabilitation
Conference:
International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function, Orlando, United States, 7 Oct - 9 Oct, 2016.
Presentation Type:
Poster Presentation
Topic:
Abstracts ISCN 2016
Citation:
Schiller
D
(2016). ABSTRACT: IMPROVEMENT WITH POSTURAL ORTHOSTATIC TACHYCARDIA SYNDROME, HEADACHES AND LIGHT SENSITIVITY IN A PATIENT WITH POST CONCUSSION SYNDROME FOLLOWING A PROGRAM OF MULTIMODAL VESTIBULAR REHABILITATION AND SPINAL MANIPULATIVE THERAPY.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function.
doi: 10.3389/conf.fneur.2016.59.00056
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Received:
31 Aug 2016;
Published Online:
07 Sep 2016.
*
Correspondence:
Dr. David Schiller, Brain, Spine & Sport, Avon, CT, 06001, United States, drschiller@comcast.net