Interprofessional Approach to Treatment of Visual and Vestibular Sequela Post-Concussion: A Case Report
Notice bibliographique
Résumé
Purpose/Objective A mild traumatic brain injury such as a concussion can have a profound impact on an individual. It can lead to headaches, photosensitivity, asthenopia, convergence insufficiency, oculomotor dysfunction, accommodative dysfunction, visual processing deficits, disruption of the vestibulo-ocular reflex and visual motion sensitivity, amongst other sequelae. Background/Rationale A 34-year old female presented to the NSU Sports Medicine Clinic 10 days following being hit by a car while riding her bicycle. She was evaluated by the sports medicine physician for initial diagnosis and treatment. She was subsequently referred to the physical therapist and then the optometric physician, all within the same interdisciplinary clinic. Methods/Methodology She presented suffering from headaches, asthenopia, photosensitivity, balance problems and dizziness and was diagnosed with a concussion. A step-wise approach to her care and careful evaluation and communication amongst three health care specialties was conducted. Results/Findings Significant improvement in her symptoms were made over the course of six months through a collaborative approach amongst these disciplines. She had ongoing care involving medical follow up with the sports medicine physician and four to six weeks of vestibular therapy focusing on balance, dizziness, vestibulo-ocular reflex and visual motion sensitivity with the physical therapist. Additionally, she received four months of neuro-optometric vision therapy/rehabilitation and additional treatment including changes in her contact lens prescription and the utilization of filters and spectacles with the optometric physician. Her refractive status, esophoria, accommodative dysfunction, oculomotor dysfunction, headaches, photosensitivity and dizziness were treated through efforts of these three disciplines. Conclusions Over many months she made tremendous improvement in her symptoms. Both objective and subjective signs and symptoms mostly or entirely resolved. Interprofessional Implications This case displays the importance of an interprofessional healthcare team in the treatment and management of a concussed patient. In this case the sports medicine physician, physical therapist and optometric physician collaborated to resolve both visual and vestibular symptoms of this young female post-concussion. The NSU Sports Medicine Clinic is one of few clinics in the country which offer such diverse interdisciplinary care to our students, athletes and community altogether. Keywords Mild traumatic brain injury, photosensitivity, vestibulo-ocular reflex, visual motion sensitivity, myopia, esophoria, accommodative dysfunction, oculomotor dysfunction, and headaches References Brown, L. & Camarinos, J. (2019). The role of physical therapy in concussion rehabilitation. Seminars in Pediatric Neurology, 30, 68-78. Gurley, J. M., Hujsak, B. D., & Kelly, J. L. (2013). Vestibular rehabilitation following mild traumatic brain injury. Neuro Rehabilitation, 32(3), 519-528. Kontos, A. P., Deitrick, J. M., Collins, M. W. & Mucha, A. (2017). Review of vestibular and oculomotor screening and concussion rehabilitation. Journal of Athletic Training, 52(3), 256-261. Mucha, A., Fedor, S., & DeMarco, D. (2018). Vestibular dysfunction and concussion. Handbook of Clinical Neurology, 158, 135-144. Murray, D. A., Meldrum, D., & Lennon, O. (2017). Can vestibular rehabilitation exercises help patients with concussion? A systemic review of efficacy, prescription and progression patterns. British Journal of Sports Medicine, 51(5). Rollett, P. & Morandi, G. (2019). Effect of vision therapy on measures of oculomotor function of patients presenting with post-concussion syndrome. Canadian Journal of Optometry, 81(4), 53-59
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