脳障害と治療

概要

Aggressive Rehabilitation Pathway Targeting Concussion Symptoms: Illustration with a Case Study

Joseph F Clark, Andrew Middendorf, Kimberly A Hasselfeld, James K Ellis and Jon G Divine

We present an aggressive rehabilitation program that addresses specific post-concussion symptoms for patients with a mild traumatic brain injury (mTBI). Our pathway is illustrated by our report of a 38-year-old female who was injured during a wind storm as a result of a direct blow to the left temporal area. In the fourth month following her injury, she was diagnosed with a right-sided central and peripheral vestibular neuropathy. She had cognitive difficulties and consistently poor multitasking abilities. After five months of brain rest and incomplete resolution of symptoms, she was referred to our program. A comprehensive rehabilitative program, including patient specific goals, was initiated to address the multiple deficiencies and symptoms to improve her quality of life (QOL). The program utilized a multidisciplinary team approach including instructing the patient on “feel better” and “get better” strategies. The patient’s progress and symptoms were continuously monitored, addressed, and targeted. Progression of activity was based upon achievement of multiple symptom-regulated goals. The program also included training cognitive function under physical stresses to return her to her pre-injury high-level of function and activity. Approximately 11 months following the concussive event she was discharged and placed on a long term maintenance program, as her QOL was essentially normal. As is typical with mTBIs, the recovery in this case was not linear and rehabilitation often evoked symptoms, but the concussion management team closely managed and addressed the symptoms. One particular intervention, the adjustment of visual acuity to 20/30 instead of 20/15, was particularly effective in reducing symptoms triggered by vision corrections. A focused, personalized rehabilitation program that targets the symptoms of a concussion helps identify and resolve concussion symptoms. This philosophy is based on traditional sports medical rehabilitation methods that first assess an injury and then work to strengthen weaknesses.