Interprofessional Approach to Treatment of Post-Concussion Symptoms following Motor Vehicle Accident in a Teenaged Patient: A Case Report

Purpose/Objective Mild traumatic brain injury such as concussion can have profound impact on an individual, resulting in short-term and possibly long-term symptoms. Symptoms can involve the vestibular system leading to poor balance and dizziness, visual system deficits leading to headaches, photosensitivity, and eyestrain with prolonged near work and loss of place while reading due to visual tracking deficits, and to neuropsychological deficits such as poor attention and concentration. Background/Rationale An 18-year-old male presented to the NSU Sports Medicine Clinic with headaches, dizziness, ocular fatigue, slow reading, and visual tracking deficits many months after suffering from whiplash in a motor vehicle accident. As a competitive soccer player he also noticed balance, dizziness and reduced peripheral awareness while on the field since the accident. He was evaluated by the sports medicine physician for initial diagnosis and treatment. He was subsequently referred to the neuropsychologist, physical therapist and the optometric physician, all within the same interdisciplinary clinic. Methods/Methodology A step-wise approach to his care and careful evaluation and communication amongst four health care specialties was conducted. Results/Findings Significant improvement in his symptoms were made over the course of six months through a collaborative approach amongst sports medicine, physical therapy, neuropsychology and optometry. He had ongoing care involving medical follow up with the sports medicine physician including osteopathic manipulative treatment for neck tension. He underwent evaluation with neuropsychology and vestibular therapy evaluation with physical therapy. Additionally, he received neuro-optometric rehabilitation/therapy and specialty tints and filters with optometry. By the end of treatment with our interdisciplinary team his balance deficits, dizziness, visual tracking deficits, convergence insufficiency, asthenopia, and headaches resolved. Conclusions Many of his symptoms were present months after his concussion. With the interdisciplinary care received at our clinic he made tremendous progress in his symptoms over many months. By the end of treatment all of his symptoms were addressed and resolved. Interprofessional Implications In this case the sports medicine physician, physical therapist, neuropsychologist and optometric physician collaborated to resolve our patient’s post-concussive symptoms. This case displays the tremendous value of an interdisciplinary health care team such as ours here at NSU Sports Medicine Clinic. Keywords Mild traumatic brain injury, concussion, whiplash, headaches, dizziness, photosensitivity, asthenopia, convergence insufficiency, oculomotor dysfunction, osteopathic manipulative treatment. References Boo, M., Matheson, G., & Lumba-Brown, A. (2020). Smooth pursuit eye-movement abnormalities associated with cervical spine whiplash: A scientific review and case report. Cureus, 12(8). Chen, J., Kouts, J., Rippee, M. A., Lauer, S., Smith, D., McDonald, T., Kurylo, M., & Filardi, T. (2020). Developing a comprehensive, interdisciplinary concussion program. SAGE Journals. DuPrey, K. M., Webner, D., & Lyons, A. (2017). Convergence insufficiency identifies athletes at risk of prolonged recovery from sport-related concussion. The American Journal of Sports Medicine. Gallaway, J., Scheiman, M., & Lynn, M. G. (2017). Vision therapy for post-concussion vision disorders. Optometry and Vision Science, 94(1), 68-73. Licciardone, J. C., Schultz, M. J., & Amen, B. (2020). Osteopathic manipulation in the management of chronic pain: Current perspectives. Journal of Pain Research, 13, 1839-1847