Improvements in Cognition and Balance Following Neurological Rehabilitation for a 23-year-old Male with Post Concussive Syndrome and Subsequent Minor Head Traumas.

OBJECTIVE: Objective is to show improvements in cognition and balance following neurological rehabilitation in patient with post-concussive syndrome (PCS) and subsequent minor head traumas.

BACKGROUND: A 23-year-old male presented to Plasticity Centers for evaluation and treatment of persistent symptoms following a sports-related concussion that occurred two years prior with subsequent minor head injuries. His symptoms included fatigue, concentration/focus difficulties, and issues when reading or looking at screens. Upon intake, he reported on the graded symptom checklist (GSC) a symptom severity score of 35. During neurocognitive testing on the C3Logix program, Trails A time was 28.8 seconds; Trails B time was 68.2 seconds; digit symbol matching score (DSMS) was 55 correctly matched digits/symbols; simple reaction time (SRT) was 303 milliseconds and choice reaction time (CRT) was 388 milliseconds. A Comprehensive Assessment of Postural Systems (CAPS®) was performed assessing balance and stability, on both a solid and foamed surface, with eyes opened, eyes closed, and multiple head positions. Average stability score upon intake was calculated as 75.8%.

DESIGN/METHODS: Three separate intensives of 4 to 5 days, with multi-modal programs of neurological exercises were administered in multiple one-hour treatment sessions over the course of 19 weeks. Each session consisted of repetitive peripheral somatosensory stimuli, cognitive exercises, neuromuscular reeducation exercises, vestibular rehabilitation exercises, orthoptic exercises, and off-vertical axis rotation utilizing a multi-axis rotational chair.

RESULTS: Upon exit, the symptom severity score decreased to 7 (-80.0%); Trails A time was 16.8 (-41.7%); Trails B time was 31.8 seconds (-53.4%). DSMS representing processing speed increased to 60 correctly matched digits/symbols (+9.1%). SRT was 253 milliseconds (-16.5%); and CRT was 319 milliseconds (-17.8%). Average stability score was calculated as 84.0% (+10.8%).

CONCLUSIONS: The authors suggest further investigation into multi-modal, intensive approaches to improve cognition, balance, and cognitive impairment in patients with PCS who have sustained subsequent minor head traumas.