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• W2511938596 abstract "Event Abstract Back to Event Improvements in balance and mental clarity in a 68-year-old male with non-traumatic dizziness following multimodal neurorehabilitation therapies Michael A. Pendleton1, Emily Styer2 and Susan E. Esposito2* 1 Southwest Brain Performance Centers, United States 2 Life University, United States Background: A 68-year-old male presented to a chiropractic brain performance clinic with a 13 year history of mental sluggishness and a 5 year history of non-traumatic dizziness and imbalance that began after dancing the hustle. The dizziness was associated with neck discomfort. The dizziness was aggravated by watching circular motions; driving in circles, driving above 80 mph; and riding in the backseat of a car. The dizziness decreased when he played cards or was otherwise distracted. Methods: A thorough physical exam was conducted. The gait exam revealed a grade 0 (normal) arm swing according to the Unified Parkinson's Disease Rating Scale (UPDRS) which degraded to a grade 2 (mild deficiency) with dual tasking. During gait testing the patient had a left lateral pulsion and had to use the wall to regain balance. The patient displayed a left hypertropia, right head tilt, high left shoulder, and a high right pelvis. The patient displayed slightly decreased deep tendon reflexes bilaterally but brisker than average plantar reflex on the left. The neurological exam revealed abnormal pursuits, gaze holding, saccades, and optokinetic reflex both downward and to the left. The patient also had decreased pupillary constriction with accommodation and decreased convergence of the right eye. Traditional cerebellar testing revealed a dysmetric finger to nose testing on the left, a mildly positive dysdiadochokinesia (DDK) on the left upon rapid alternating palms up/palms down movements and a positive heel to toe tandem walk test with a fall to the left. Standing on one leg with eyes open (SOLEO) test had a 7 second duration on the right leg and a 1 second duration on the left with severe sway. Additionally, the patient was unable to perform Comprehensive Assessment of Postural Systems (CAPS) testing while standing on a foam surface due to a fall when his head was positioned in left rotation and in extension. The patient displayed symptoms consistent with a chronic left cerebellar flocculonodular dysafferentation. Additionally his test results suggested a left otolithic physiological lesion most likely affecting the utricle, conveying a feeling of imbalance and change in his subjective visual vertical, skew deviation and right head tilt. Furthermore the clinician suspected the patient's long standing scoliosis was secondary to the cerebellar weakness on the left which may have affected optimal function of the left vestibulospinal pathways. A program of vestibular and oculomotor rehabilitation along with spinal manipulative therapy was initiated to address the exam findings. The patient was also given home exercises to be performed daily. The treatment plan included specific modalities targeted to increase the frequency of firing of the left cerebellum through functional neurological brain based stimulation while increasing the central integrative state of the left otolithic complex and evoking neuroplastic changes. The modalities included somatosensory evoked potential (SSEP) stimulation, pulsed electromagnetic field therapy, low level laser therapy and neuromuscular rehabilitation. The treatment plan frequency included office treatments on a 2 or 3 times daily treatment schedule for one week basis with daily re-evaluation. Results: After daily treatments for one week, and supported by daily at home exercises, the patient subjectively reported a 50% improvement in mental clarity and a 30% improvement in balance. After 1 week, the patient's balance had improved objectively as measured by his average center of pressure (avgCOP) on the CAPS instrument. Initially with his eyes open, his head in neutral and standing on a solid surface the patient had a posterior avgCOP sway (-3.70AP) and after 1 week the patient showed a decrease in the posterior avgCOP sway (-1.6AP). Initially with his eyes closed, his head in neutral and standing on a solid surface the patient had a posterior avgCOP sway (-3.60AP) and after 1 week the patient showed a decrease in the posterior avgCOP sway (-1.9AP). Following the one week intensive care plan, the patient subsequently had 3 follow up treatments, each 2 weeks apart, during which time he continued with daily home exercises. At the 4 week follow up, the clinician noted normal cerebellar and vestibular test results. This included normal finger to nose, normal rapid alternating movements with fingers and feet, normal heel to toe tandem walking, and normal heel to shin testing. Additionally, SOLEO was 10 seconds on the right leg with mild sway and 10 seconds on the left with moderate sway. At the 6 week follow up the patient reported vast improvement in mental clarity. At the 2 month follow up visit the patient showed improvement in his ability to perform cross cord exercises. At the 5 month follow up visit the patient still displayed normal cerebellar and vestibular testing, including finger to nose, rapid alternating movements with the fingers and feet, heel to toe tandem walking and heel to shin testing; however SOLEO testing had regressed back to 1.2 seconds on the left leg. At the one year follow up visit the patient had made great progress overall but was still not symptom free. Objectively his overall balance and gain were much better but still showed some left vestibulocerebellar deficiencies. SOLEO testing was still decreased on the left leg. Conclusion: The patient experienced some marked improvements with the use of multimodal neurorehabilitation for his mental clarity, balance and coordination, however at the 1 year follow up visit some balance deficiencies still existed. The authors suggest further investigation of the use of multimodal neurorehabilitation for cases of mental sluggishness, imbalance and incoordination. Keywords: Balance control, Dizziness, Chiropractic, chiropractic neurology, Neurorehabilitation 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: Pendleton MA, Styer E and Esposito SE (2016). Improvements in balance and mental clarity in a 68-year-old male with non-traumatic dizziness following multimodal neurorehabilitation therapies. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function. doi: 10.3389/conf.fneur.2016.59.00045 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 29 Aug 2016; Published Online: 07 Sep 2016. * Correspondence: Dr. Susan E Esposito, Life University, Marietta, United States, susanesposito@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Michael A Pendleton Emily Styer Susan E Esposito Google Michael A Pendleton Emily Styer Susan E Esposito Google Scholar Michael A Pendleton Emily Styer Susan E Esposito PubMed Michael A Pendleton Emily Styer Susan E Esposito Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page." @default.
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• W2511938596 title "Improvements in balance and mental clarity in a 68-year-old male with non-traumatic dizziness following multimodal neurorehabilitation therapies" @default.
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