Combined Optokinetic Treatment and Vestibular Rehabilitation to Reduce Visually Induced Dizziness in a Professional Ice Hockey Player After Concussion: A Clinical Case

Abstract

Background: The appropriate detection and therapy of concussion symptoms are of great importance to avoid long-term impairment and absence from pre-concussive activities, such as sport, school or work. Post-traumatic headache and dizziness are known as risk factors of persistent symptoms after a concussion. Dizziness has even been classified as a predictor for symptom persistence. One type of dizziness, which has never been considered is visually induced dizziness (VID) often develops as a consequence of vestibular impairment. This manuscript presents the clinical case of a 25-year-old male, professional ice hockey player, whereby a therapeutic approach to VID after concussion is demonstrated.Case: A detailed interdisciplinary clinical and laboratory-assisted neurological, neurovestibular and ocular-motor examination was performed 20 days post-concussion, which indicated VID symptoms. Thus, the player qualified for a 5-day combined vestibular, balance and optokinetic therapy, which aimed to reduce the player's increased sensitivity to visual information. Each treatment day consisted of two sessions: vestibular/ocular-motor training and exposure to optokinetic stimuli combined with postural control exercises. The optokinetic stimulus was delivered in the form of a rotating disk. VID symptoms were recorded daily via posturography and a visual analog scale prior to the optokinetic sessions. The player improved over the course of each treatment day and was able to return to ice hockey 15 days after the final treatment session. Three months later the player reported no symptoms in the follow up questionnaire.Conclusion: The combination of vestibular, balance and optokinetic therapy led to remission of VID symptoms in a professional ice hockey player after multiple concussions, within a short time frame after his last concussion. Thus, this case study highlights the significant benefit of treating post-concussive VID symptoms utilizing a multi-modal approach.

Visual Perception in Migraine: A Narrative Review

“…A relationship between PPPD and migraine has been suggested [ 97 ]. Interestingly, PPPD can be visually triggered [ 98 ], as can motion sickness. Most likely motion sickness and PPPD intermingle.…”

The Effectiveness of Non-pharmacological Treatments for Vestibular and Oculomotor Deficits in Post-concussive Syndrome: a Protocol for a Systematic Review and Meta-analysis

“…Case studies have shown VOR disruption in those with PCS (25,26). Common complaints of vestibular dysfunction include dizziness, vertigo, nausea, fogginess, unsteady gait, and postural instability (20,27). Symptoms associated with oculomotor dysfunction include double vision, di culty tracking objects or focussing, motion sensitivity, photophobia, eye strain, and headache (20,27).…”

“…Common complaints of vestibular dysfunction include dizziness, vertigo, nausea, fogginess, unsteady gait, and postural instability (20,27). Symptoms associated with oculomotor dysfunction include double vision, di culty tracking objects or focussing, motion sensitivity, photophobia, eye strain, and headache (20,27). Importantly, evidence has shown that these symptoms of vestibulo-ocular dysfunction are strong predictors of delayed recovery in PCS (19,20,23).…”

Measuring optokinetic after-nystagmus: potential for detecting patients with signs of visual dependence following concussion

“…Occurrence, or worsening, of dizziness during exposure to environments with complex visual stimuli (e.g. supermarket aisles, busy crossroads) is commonly reported by concussed patients [ 12 , 13 ]. Such symptoms are well known in patients with vertigo of various aetiologies and have been defined as a syndrome of visual vertigo [ 14 ] or visually induced dizziness (VID) [ 15 ].…”

“…Considering the reports on concussed patients who present symptoms compatible with visual dependence [ 12 , 13 ], we hypothesized that in selected concussed patients with persisting, strong dizziness after visual stimuli the VSM is overacting when it extracts self-motion information from visual cues. To evaluate this hypothesis, we analysed OKAN of patients who showed signs and symptoms supporting impaired central integration of visual information after a concussion.…”