Post-Concussion Syndrome Recovery with Functional Neurology: A Patient's Story
- Joseph Coppus
- May 19
- 5 min read
This is a first-hand account of Dr. Coppus' experience treating a patient with post-concussion syndrome. The purpose of this blog post is to present the details of a real case and educate the reader on common symptoms of post-concussion syndrome, as well as showcase how functional neurology can improve concussion recovery. Readers can expect to come away with a deeper knowledge of post-concussion syndrome, along with the struggles and triumphs. Please share if you or someone you know is experiencing a story similar to the one you're about to read.
Anna's Story
The patient is a young adult female who initially sought care with us after sustaining a sports-related concussion. We won't disclose specific information about the patient, but for the sake of this review, we will call her Anna. Anna's head injury occurred roughly six months before she sought care in our office. Her main symptoms included dizziness, headaches, brain fog, fatigue, and sensitivity to light, sound, and motion. These symptoms made it nearly impossible for her to continue with school and sports, causing her to drop out for the semester. She wasn't able to go out with friends or go to concerts like she loved to do. Despite being a young woman with so much potential, Anna was sidelined and had to watch life go on without her.
Prior to her experience with our clinic, Anna had tried all the traditional approaches, such as resting and avoiding things that triggered her symptoms; however, she felt stuck and was not seeing improvement, despite following her doctors' recommendations. Her MRI was negative, and there were no positive lab findings. She had then tried acupuncture, chiropractic, physical therapy, and vestibular therapy with no luck. After months of continuing to struggle and get back to her normal life, Anna was told about our clinic by a family member, who suggested she get evaluated. She figured she had nothing to lose and decided to give it a try.
Evaluation
I clearly remember the first day Anna came in for her initial exam. Anna, sporting dark sunglasses and her mother at her side, offered assistance into the clinic and onto the exam table. Anna was having an especially difficult day, her mother told me, but wanted to push through and see if I could come up with any answers for her. Our exam process is typically three hours long, so I made sure to remind Anna that we can take breaks at any time and to let me know how we can best accommodate her.
During our evaluation, we tested several things related to post-concussion syndrome and overall brain function. We began with a thorough autonomic evaluation, followed by a comprehensive cognitive assessment. We then performed VNG (Video Nystagmography) testing to more clearly observe any eye movement irregularities (extremely common in post-concussion syndrome), and then an in-depth balance assessment. We gave her a little break after this, before talking more about how the injury had been impacting her day-to-day life and what her goals for care were. After this break from testing, I performed even more physical bedside neurological tests. During this phase of the exam, we tested her sensory and motor function, cranial nerves, reflexes (deep tendon, pathological, and primitive), vestibular function, eye movements, pupillary response, and more.
Results from our evaluation showed that Anna had a vestibular imbalance, autonomic instability, eye tracking issues, and delayed pupillary response. While no head injury is the same, these findings are all common and consistent things we see following a concussion with subsequent unresolved symptoms. Not only that, they were all consistent with the chief symptoms she was experiencing. I was able to show Anna quantifiable evidence of what we were seeing and explain why her symptoms may be occurring as a result of the previously mentioned findings. Her immediate response was relief and renewed hope. Finally, she had observable evidence that she wasn't just "making up her symptoms"; it wasn't just "anxiety", nor were her symptoms "all in her head" like she was being led to believe. I then told her that all of these findings are manageable and reversible with appropriate neurological rehab and that I believed I could help her.
Now that we had found Anna's problems, it was time to get to work fixing them.
Treatment
We decided that the best course of action for her unique situation and recovery was to get her on a three-times-a-week treatment plan for one month, followed by a reevaluation. Anna was eager and adhered to her treatment plan throughout the month. Her care plan also included at-home exercises to complement her work in the clinic and supplement suggestions geared towards aiding in her recovery.
To address Anna's symptoms and injury, we had to structure her treatment plan specifically to her test findings and to meet her goals. Chiefly, we worked on stabilizing her eyes, vestibular system, and autonomics through vestibular exercises, gaze stability exercises, trigeminal and vagus nerve stimulation, red light therapy, and tilt table therapy.
The first piece I wanted to address with Anna was her vestibular imbalance. Because the vestibular system is one of the most foundational aspects of the nervous system and interwoven with several other systems, we wanted to address this first and foremost. We accomplished this by utilizing specific modified Epley maneuvers, Halmagyi head impulse thrusts, and vestibular ocular reflex therapies. Next, we wanted to concurrently rehabilitate her eye movements and autonomic nervous system. To address her autonomic nervous system, we paired a combination of tilt table therapy, Normatec compression boots, trigeminal and vagal nerve stimulation, with Zona grip strength training. To improve her eye movements, we employed different gaze stability, pursuit, and saccadic eye movement exercises.
As her core treatments started to stabilize her findings, we began employing more integrative therapies to tie everything together. These consisted of the D2 Dynavision eye-hand coordination exercises, Interactive Metronome, and the Motion Guidance NeuroStation.
Outcome
Anna responded very well to treatment. She didn't notice any immediate changes after the first two visits; however, by the third visit, she noticed a positive change in her dizziness. Then, after the second week, her headaches were noticeably lower, and her dizziness was even less. By the end of the third week, she noticed that she was thinking more clearly, lights and sounds weren't as stimulating, and her energy was improving.
Once the fourth week had concluded, and we performed her re-exam, Anna had realized a 75% improvement in symptoms compared to her initial exam. Her eye movements were markedly improved, her autonomic nervous system was more stable, and she wasn't showing any discrepancies in vestibular function.
Anna and I discussed her progress and determined that a pace of once a week over the next four weeks would be suitable to continue her active treatment, while continuing to enable her to be more and more self-sufficient with her at-home therapies. Her symptoms were nearly resolved after two months of active care. Anna was recommended to continue her at-home exercises for three additional months with two additional follow-up visits to monitor her progress.
Anna was able to return to school and her sport with virtually no symptoms and is feeling back to her normal. It was a long and difficult journey for her, but I feel grateful that we were able to give her hope again and get her back to living the life that she enjoyed.
Concluding Thoughts
Concussions can be incredibly debilitating and life-altering. Many patients are written off and disregarded if they don't recover in the 'expected timeline'. If you or someone you know is struggling with chronic symptoms after a concussion, don't lose hope. There are still many options for recovery. If you would like to see if this type of care is right for you or your loved one, feel free to give our office a call at (614)-706-2093 or contact us through our website.
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