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Improvements in Stability Scores, Cognition, and Reduced Symptom Severity Score Following Neurological Rehabilitation for a 35-year-old Female Professional Skier with Post-Concussive Syndrome

Emily R. Kalambaheti1*, Megan Manno2 and Matthew M. Antonucci1, 3
  • 1 Plasticity Brain Centers, United States
  • 2 University of Central Florida, United States
  • 3 Carrick Institute, United States

Presentation: A 35-year-old female professional skier presented to Plasticity Brain Centers for evaluation and treatment of post-concussive syndrome (PCS) following sport related injuries. She reported that she was no longer able to ski, and that her symptoms included headache, earache, nausea, dizziness, and fatigue. Findings: When asked to rate her symptoms on a graded symptom checklist (GSC) (Simon 2017), she reported a score of 65. Her Trails A time was 22.7 seconds (50th percentile equals 24.4 seconds). On the standardized assessment of concussion, she scored 26 out of 30. A Comprehensive Assessment of Postural Systems (CAPS®) (Pagnacco 2014) was performed assessing balance and stability, on a solid and foamed surface, with eyes opened and closed with head in different positions. Her average stability score was 79.925%. Methods: A 8-day, multi-modal program of neurological exercises was administered in 18 one-hour treatment sessions (Carrick 2017) that consisted of repetitive peripheral somatosensory stimuli, neuromuscular reeducation exercises, vestibular rehabilitation exercises, orthoptic exercises, cognitive exercises, and off-vertical axis rotation (Gdowski 1999) utilizing a multi-axis rotational chair (MARC). Outcome: Upon exit, the symptom severity score decreased to 23 (-64.6154%). Her Trails A time (Salthouse 2011) decreased to 11.1 seconds (-51.1013%). The standardized assessment of concussion score increased to 29 (+10.3448%). Her average stability score increased to 85.987% (+7.58%) Conclusion: The authors suggest further investigation into multi-modal, intensive approaches to decrease symptom severity, improve cognition, and improve stability scores in patients with PCS.

Acknowledgements

The authors would like to thank and acknowledge the contribution of the clinical team at Plasticity Brain Centers as well as the administrative support team. The authors would also like to thank the Carrick Institute for providing the education utilized to create the multi-modal treatments implemented in this case study.

References

1. 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

2. Galetta KM, Liu M, Leong DF, Ventura RE, Galetta SL, Baleer LJ. (2015) The King-Devick test of rapid number naming for concussion detection: meta-analysis and systematic review of the literature. Concussion. (2015) doi: 102217/cnc.15.8

3. Gdowski GT, McCrea RA. Integration of vestibular and head movement signals in the vestibular nuclei during whole-body rotation. J Neurophysiol (1999) 82:436–49

4. Olson BL, Oberlander TJ, Weidauer L (2017) Test-Retest Reliability of the King-Devick Test in an Adolescent Population. J of Athletic Training. 2017;52(2):000–000. doi: 10.4085/1062-6050-52.2.12

5. Salthouse T. What Cognitive Abilities are Involved in Trail-Making Performance? Intelligence. 2011 July-August; 39(4): 222–232.

6. 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: Ski injury, concussion rehabilitation, concussion, Post-Concussion Syndrome, Post-concussive syndrome, Vestibular Rehabilitation, Off-vertical axis rotation, Neurorehabilitation, Neurology, Functional Neurology, chiropractic neurology, orthoptic exercises, non-invasive nerve stimulation, Somatosensory Evoked Potentials (SEP), stability score

Conference: International Symposium on Clinical Neuroscience 2018, Orlando, Florida, United States, 24 May - 26 May, 2018.

Presentation Type: Poster

Topic: Clinical Applications in health, disease, and injury to the nervous system

Citation: Kalambaheti ER, Manno M and Antonucci MM (2018). Improvements in Stability Scores, Cognition, and Reduced Symptom Severity Score Following Neurological Rehabilitation for a 35-year-old Female Professional Skier with Post-Concussive Syndrome. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience 2018. doi: 10.3389/conf.fneur.2018.60.00109

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Received: 02 Apr 2018; Published Online: 14 Dec 2018.

* Correspondence: Dr. Emily R Kalambaheti, Plasticity Brain Centers, Orlando, United States, Emily.Kalambaheti@gmail.com