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Abstract

Purpose: The purpose of this case study was to examine the effectiveness of integrated vision and vestibular therapy for an individual with oculomotor and vestibular system impairments secondary to a concussion further defined as vestibulo-ocular post-concussion disorder. A secondary purpose was to suggest an appropriate timeline to introduce vision therapy and integrate vestibular rehabilitation therapy based on protocol used in an outpatient concussion rehabilitation clinic.

Method This was a case study on a 16-year-old female with protracted concussion recovery. Treatment consisted of 9 in-clinic visits for vision therapy with the final 6 visits addressing vision and vestibular deficits. A home exercise program supplemented the weekly clinic sessions. Outcomes measures included the Activity-Specific Balance Confidence Scale (ABC Scale), Brain Injury Vision Symptom Survey (BIVSS), Convergence Insufficiency Symptom Survey (CISS), Dizziness Handicap Inventory (DHI), and Post-Concussion Symptom Scale (PCSS). Improvements in vision and vestibular function were assessed with a comprehensive visuo-vestibular re-evaluation at discharge and 5 month follow up.

Results: Improvements in oculomotor control, vergences, vestibular function, and symptomology were reported and measured at discharge and corresponded with clinically meaningful functional outcome improvements. The patient improved from 68% to 96.88% on the ABC (<67% indicates fall risk); 78 to 14 on the DHI (MDC 17.18 points, MCID 18 points); and 46 points to 10 points on the PCSS (MCID 6.8 points). Improvements were maintained at 5 month follow up, despite occurrence of two subsequent subconcussive head injuries. The patient reported improvements in participation in social activities and academic performances at follow up.

Conclusion: Results from this case study suggest integrated vision and vestibular therapy, when done in the appropriate timeline, may be used to efficiently and effectively manage vestibulo-ocular post-concussion disorder.

Author Bio(s)

Lauren Ziaks, DPT, ATC

After extensive training and a vision therapy mentorship with an Occupational Therapist from the VA network, Lauren created a comprehensive concussion practice in Park City, Utah. She specializes in vision and vestibular rehabilitation therapy for protracted recovery. She is co-founder of phoenixconcussionrecovery.com which provides education and management guidelines for concussion recovery.

Rosemary Giardina, DPT

Rosemary studied under Lauren Ziaks at her concussion practice in Park City, Utah while a student at The Ohio State University. She now practices in neurologic rehabilitation and is completing a neurologic physical therapy residency through Marquette University and the Zablocki VA Medical Center.

Anne Kloos, PT, PhD, NCS

Anne Kloos, PT, PhD, NCS is a Professor in the PT Division at Ohio State University. She teaches adult neurorehabilitation and vestibular rehabilitation courses and conducts clinical research on individuals with neurodegenerative diseases. She’s authored a chapter on vestibular/cerebellar disorders in Neurologic Rehabilitation: Neuroscience and Neuroplasticity in Physical Therapy Practice.

Acknowledgements

We would like to acknowledge our research site Wasatch Physical Therapy & Sports Medicine for their support in the development of these protocols. Lauren Ziaks was employed at this facility when the study was conducted. Rosemary Giardina was on clinical rotation at The Ohio State University when this study was conducted.

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