Case Study - Rehabilitation of Post Concussion Syndrome

Intervention

TREATMENT FOR BALANCE & VISUAL PROCESSING

A component of the treatment plan will include interventions to address the limitations in balance, postural control and dizziness/associated visual tracking limitations, following a similar protocol to the Fowler-Kennedy guidelines.

The balance limitations will be addressed first working on basic balance exercises as follows:

1)    2 feet to one foot,

2)    changing the surface (firm to foam surfaces),

3)    eyes opened and closed

These exercises will address the basic systems contributing to balance. We can progress these basic exercises as follows:

-       Inclination of the surface may be changed

-        Add internal perturbations such as moving other limbs, changing BOS – i.e tandem stance

-       Add a dual task component (adding cognitive tasks while maintaining balance)

The visual tracking/dizziness limitations will be addresses through vestibulo-ocular reflex (VOR) exercises which may include the following:

1)    Substitution exercises – move eyes to a target and then head

2)    VOR exercises: keep focused on target while shaking head back and forth - do it by moving head side to side, up and down.

Once balance and VOR factors have been addressed they can actually be combined in order to increase the level of difficulty within the tolerance of the patient. For example, standing on a bosu-ball (challenging balance) while keeping eyes focused on a target while moving head back and forth.