A methodological approach can save you time and money
The case of a 66 year-old female patient sustained a concussion after having tripped over an object and struck her head against the concrete. She was left with many symptoms, the worst ones being depressed and anxious mood, neck pain, headache and insomnia. She had initially sought help from a sports physiotherapy clinic in Vaughan with no relief in her symptoms.
After a thorough intake history, physical exam and neurocognitive assessment a plan was made to help her with her problems. She had a lifelong history of anxiety and depression and so her family doctor and psychiatrist were also involved in her care.
She was immediately enrolled in CBT-i which proved to be successful in correcting her insomnia without the need for medication. She received customized energy management recommendations and lifestyle accommodation strategies. She also received coaching on how to perform relaxation strategies.
After 2 weeks in the program, she developed BPPV which caused her a great deal of anxiety. This was promptly treated and corrected by the team. As can be the case after concussion, this condition was recurrent for about 2 weeks and she needed our team to assess the location of the crystal and reposition it on 4 occasions over those 2 weeks until it finally went into remission for good. The consequences of BPPV created a mild imbalance in the way she reconciled sensory input coming from her visual, vestibular and somatosensory system and led to some symptoms of imbalance and dizziness. She received vestibular therapy for this.
Her binocular vision exam showed convergence insufficiency and she was all set to do vision therapy, but for various personal reasons, there was a delay.
She did continue with occupational therapy and chiropractic therapy (for vestibular therapy) and after another month her symptoms had completely disappeared. Her binocular vision assessment was repeated and showed that it had completely resolved without the need for vision therapy.
Written by: Dr. Taher Chugh
Last update: June 2018