Effectiveness of chiropractic neurorehabilitation therapy in a 19-years-old female with post-concussion syndrome and idiopathic post-infectious hypersomnia
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1
Innova Brain Rehabilitation, United States
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2
Life University, United States
Background:
A 19-years-old female presented to a chiropractic neurology clinic with a previous diagnosis of post-concussion syndrome and idiopathic hypersomnia by her medical neurologist. Her chief complaints included daily headaches, photophobia, cognitive and emotional instability. The patient had a history of six concussions that she sustained from grade school through high school, all of which occurred playing soccer. Hypersomnia developed following a mononucleosis infection in first grade. Syncopal episodes were also reported during this time frame as well as epistaxis events. These chief complaints were affecting her school and sports performance, as well as all activities of daily living.
Methods:
Examination revealed a flat and mildly reticent affect. Autonomic dysregulations showed a V:A ratio of 3:2 bilaterally. Anisocoria was present, and decreased left pupil constriction during direct light reflex was noted. Video-oculography (VOG) displayed a high frequency of square wave jerks without fixation and in all planes of gaze holding. Smooth pursuit activity also revealed saccadic intrusions in both the horizontal and vertical planes with a decreased gain in both planes. The patient had a right head tilt and concomitant left hypertropia. Cranial Nerves evaluation revealed hypersensitivity over the left V1 and V2 trigeminal regions, tight and tender left masseter, and tongue protrusion resistance was graded 4/5 on the left. Examination of rapid alternating movement demonstrated mild dysdiadochokinesia on the left at both the shoulder and elbow. The finger tapping test was graded a 1 for speed on the left hand. Upon gait evaluation, a markedly decreased bilateral arm swing was noted. Additionally, dual tasking produced left lateral pulsion during the left leg swing phase. Extraspinal and spinal segmental motion dysfunction involving the scapula-thoracic, chondro-sternal, and cervical region were additionally noted.
The patient underwent intensive treatment for five consecutive days. Treatment consisted of horizontal and vertical gaze stability exercises, vertical pursuits and Brock bead vergence exercises. Additionally, the patient was rotated in left yaw and forward pitch using a whole-body off-vertical axis rotational device (OVARD). Therapy also included repetitive peripheral sensory stimulation on the left posterior tibial and distal peroneal nerves. Complex multiplanar movements of the left upper and lower extremities, and spinal and extraspinal manipulative therapy were utilized. Home exercises were prescribed which consisted of breathing exercises, complex multiplanar movements of the left upper and lower extremities, active gaze stability exercises, and left chair rotations. Exercises were modified to accommodate progression of the patient’s recovery.
Results:
Re-evaluation revealed equal pupil size and a V:A ratio of 2:1 bilaterally. The hypersensitivity of the left V1 and V2 trigeminal regions was resolved. The patient was no longer dysdiadochokinetic on rapid alternating movements testing. Gait examination showed appropriate arm swing and consistent stride length. VOG displayed a significant reduction in the frequency of square wave jerks in all planes of gaze holding. Smooth pursuit activity revealed diminished saccadic intrusions in both horizontal and vertical planes with increased gain in both planes. Finger tapping was graded 0 bilaterally. Patient reported resolution of all post-concussion syndrome symptoms as well as hypersomnia.
Conclusion:
The positive outcome of this case demonstrates the effectiveness of chiropractic neurorehabilitation therapies in the treatment of post-concussion syndrome and idiopathic hypersomnia. Further studies are suggested to explore the efficacy of chiropractic neurology treatments in patients presented with the same symptomatology.
Keywords:
Post-Concussion Syndrome,
Hypersomnia,
chiropractic neurology,
Neurorehabilitation,
Headaches
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:
Duffy
JL,
Jimenez
C and
Esposito
SE
(2018). Effectiveness of chiropractic neurorehabilitation therapy in a 19-years-old female with post-concussion syndrome and idiopathic post-infectious hypersomnia.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience 2018.
doi: 10.3389/conf.fneur.2018.60.00127
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Received:
05 Apr 2018;
Published Online:
14 Dec 2018.
*
Correspondence:
Dr. Susan E Esposito, Life University, Marietta, United States, susanesposito@gmail.com