CASE STUDY Two females age 24 and 34 were re-ferred to the author from other health care providers for further assessment and management of their PPCS which remained refractory to previous inter-vention. Previous management in-cluded: vestibulo-ocular rehab, aerobic exercise, psychotherapy, vision therapy, manual therapy for the cervical spinal, acupuncture, medication and suboc-cipital nerve blocks. A 24 year old female, enrolled in teach-ers college presented with PPCS of 14 month duration. She was injured after being elbowed in the head while falling out of a towable-water tube during summer vacation. At the time of pres-entation previous treatment included: vestibular rehabilitation, suboccipital nerve blocks, vision therapy, cervical manual therapy, and occupational therapy. Previous diagnostics included: MR imaging, CT scan, radiographs, and blood panel, all of which were in-terpreted as normal. Her symptom burden at initial as-sessment included: significant anxiety particularly with visual motion and egocentric motion, dizziness, social irritability, poor short term memory, left sided tinnitus, neck pain, frontal and suboccipital headaches, motion sickness, and sensitivity to light and sound. She scored 54 on RPQ, 90 on PCSS and 16 on PHQ-9. Physical examination was completed and revealed: a pleasantly interactive woman, with good attention and focus. Pulse 97, right sided BP 133/83, left sided BP 135/84. Oxygen saturation was 99%. Gait was grossly normal. Upper and lower extremity light and sharp touch, as well as, joint position sense was normal. Pathological reflexes were absent. Reflexes were 2+ bilater-ally at all levels. No evidence of pyram-idal paresis, atrophy, flaccidity, spastic-ity or motor spontaneity noted. Infrared video goggle (VOG) assessment re-vealed downbeat nystagmus with vision occluded. This was present in all seated head positions (ie: head right, left, up, down, and tilted). Downbeat nystag-mus was also produced in all directions of gaze eccentricity (ie: right, left, up, down). Bedside assessment of smooth pursuits reveals saccadic intrusions in www.Cndoctor.ca CASE 1 Multi-system management Persistent post-concussion syndrome case series T BY DR. DYLAN RODGERS, DC >10 – 14 days in adults and > 28 days in children (2). PPCS may include: nausea, dizziness, headaches, blurred vision, poor sleep, auditory distur-bances, reduced executive function and emotional liability(1). Currently, re-search supports an active symp-tom-based return to activity for indi-viduals recovering from concussion. The Berlin consensus statement rec-ommends 24-48 hours of rest before gradual return to activities(2). Active treatments may include: sub-symptom threshold aerobic exercise, cervical, vestibulo-ocular, and cognitive thera-pies(3). BACKGROUND DR. DYLAN RODGERS B.Sc. DC. graduated from Queen’s University in Kingston where he completed his Bachelor of Science (Hons.) with an emphasis in human physiology and neuroanatomy. He then completed his chiropractic training at Canadian Memorial Chiropractic College in Toronto Ontario. Dr. Rodgers furthered his education by completing a three-year fellowship in Clinical Neuroscience and Rehabilitation at the Carrick Institute for Graduate studies. 16 Chiropractic and Naturopathic Doctor July/August 2022 Photo: © Pixel-Shot / Adobe Stock he purpose of this case series is to present the clinical assessment and diagnosis of two patients with persistent post-con-cussion symptoms who remained refractory to typical interventions, and to discuss the outcomes of an individualized, tar-geted, multisystem management pro-vided by a chiropractor. Concussions are among the most common neurological conditions, rep-resenting a substantial burden to adults and children(1). Persistent post-con-cussion symptoms (PPCS) are defined as symptoms that persist beyond the expected clinical recovery time frame,
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