The Emerging Role of Vestibular Stimulation in Brain Rehabilitation: A Representative Case Report

The number of literature reports suggesting that various types of electrical, optokinetic, caloric, and mechanical vestibular stimulation may enhance recovery of function in patients suffering from traumatic and degenerative brain disorders is growing. This case report describes the integration of vestibular stimulation techniques into a rehabilitation treatment plan of a traumatically brain injured 16-year-old patient who had failed to sustain recovery after a course of standard care. His intractable signs and symptoms included headache, brain fog/mild cognitive impairment and disequilibrium which made participation in his chosen sport, hockey, virtually impossible.   His symptoms developed following a concussion while playing hockey.  He was treated by the team’s designated sports specialist and eventually cleared to return to play, however he was rapidly re-concussed. At the time he presented for evaluation, a battery of tests was conducted and clearly supported the reoccurrence of his symptoms. His baseline scores were Graded Symptom Checklist symptom severity 46, Standard Assessment of Concussion 25/30, BESS Balance Score 14, Trails Test A 15.0, Trails Test B 27.4, Processing Speed Task 63, Reaction time simple 255 and Reaction time choice 469. Standard methods of rehabilitation including Gaze Stabilization Exercises and Progressive Balance Exercises were augmented with vestibular stimulation through the use of skull vibrations and optokinetic stimulation. After 18 treatments over approximately six weeks of rehabilitation augmented with vestibular stimulation, findings associated with mTBI normalized and he was able to resume his full participation in sporting activities.  His post treatment scores were. Graded Symptom Checklist symptom severity 1, Standard Assessment of Concussion 24/30, BESS Balance Score 5, Trails Test A 12.4, Trails Test B 34.0, Processing Speed Task 64, Reaction time simple 245 and Reaction time choice 385. He remained asymptomatic at 4 months follow-up post discharge and is participating fully in team hockey activities. This case report describes the integration of vestibular stimulation into neurorehabilitation protocols which appeared to be associated with sustained reduction in disability and improved treatment-refractory symptoms in a patient with traumatic brain injury. It adds to the growing knowledgebase supporting the role of vestibular stimulation as an adjunct modality in the rehabilitation of brain disorders.