Event Abstract

Multimodal neurorehabilitation for treatment of mild traumatic brain injury

  • 1 Southwest Brain Performance Centers, USA
  • 2 Life University, USA

Background: A 14-year-old female presented with a chief complaint of sleep disturbance and fatigue. She also complained of frequent headaches, neck and back pain and diminished memory. These complaints started immediately after hitting her head and sustaining a severe concussion during cheerleading practice. Methods: A thorough neurological assessment revealed dysdiadochokinesia (DDK) and ataxic movements on the right, right lateral pulsion on tandem gait and Romberg’s testing created an immediate posterior to anterior sway. Hypertropia, decreased pupillary constriction and decreased convergence were observed in the left eye and hypometric saccades were detected in all horizontal and vertical planes. Optokinetic (OPK) stimulation revealed aberrant nystagmus and initiated blepheroclonus of the right eye. Attempts at gaze stabilization failed and resulted in facial and body titubations. During point localization testing the patient was unable to differentiate between the toes of her right foot and was unable to do so on the left when left and right were tested simultaneously. A rhythmic tremor was observed on tongue protrusion with greater amplitude to the right. Finally, mental status evaluation revealed an inability to perform verbal or visual recall (0/4 words) within a fifteen-minute time frame. The patient rated herself on a Subjective Units of Distress Scale (SUDS) with a score of 60 units out of a possible 100 meaning she was anxious and distressed enough to interfere with performance. The Rivermeade Post-Concussion Questionnaire (RPQ), which rates the severity of 16 symptoms associated with post-concussion syndrome, was measured at a 26. The patient was managed with multimodal treatments that consisted of a combination of passive and/or active complex movements on the right upper and lower extremity, passive gaze stabilization and near-far accommodation exercises using a Brock string. Somatosensory evoked potential stimulation was used on the face and extremities. Epley's canal repositioning maneuver of the right posterior canal was performed once during one session. Treatment also included saccades to small targets in an oblique right and upward direction, followed by pursuits in an oblique left and downward direction, sinusoidal gait therapy, left horizontal OPK stimulation and neurosensory integration of eye-hand reactions and somatosensory stimulation. Results: After five days of treatment, three times per day, the patients’ objective and subjective measures improved greatly. The patient reported significantly less neck and back pain and was able to sleep well. She reported experiencing increased energy. The SUDS score was lowered to a 30 out of 100 revealing that she only had mild anxiety that no longer interfered with her daily performance. The Rivermeade Post-Concussion Symptom assessment score was lowered to 12. All the previously tested movement and balance measures were near normal limits. Conclusions: The improvement seen in this case advocates for further research into the use of multimodal neurorehabilitation for the management of persistent symptoms associated with mild traumatic brain injury.

Keywords: Traumatic brain injury (TBI), Neurorehabilitatation, Neurorehabilitation after Brain Injury, Chiropractic, Fatigue

Conference: International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function, Orlando, USA, 7 Oct - 9 Oct, 2016.

Presentation Type: Poster Presentation

Topic: Abstracts ISCN 2016

Citation: Pendleton MA, Baelde ER and Esposito SE (2016). Multimodal neurorehabilitation for treatment of mild traumatic brain injury. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function. doi: 10.3389/conf.fneur.2016.59.00002

Received: 28 Aug 2016; Published Online: 07 Sep 2016.

* Correspondence: Dr. Susan E Esposito, Life University, Marietta, USA, susanesposito@gmail.com

© 2007 - 2016 Frontiers Media S.A. All Rights Reserved