Overview: Persisting post-concussive symptoms (PPCS), defined as three or more symptoms persisting beyond three months after mild traumatic brain injury, affect 24-43% of concussed individuals and cause substantial occupational disability. This case series of two working-age men with PPCS > 12 months documents multimodal neurorehabilitation and objective recovery metrics alongside return-to-work outcomes.
Therapeutic Interventions: Both patients received an individualised multimodal neurorehabilitation program comprising the following modalities applied at patient-specific dose and progression: Vestibular stimulation via the Orbital multi-axis rotational chair, incorporating sagittal roll, yaw, and pitch planes as determined by individual assessment findings; Saccade and pursuit rehabilitation using a weighted head-mounted laser with computer-generated random target panels in LARP and RALP diagonal planes; Sensorimotor integration exercises including backwards treadmill walking with ankle weights and con-current juggling (P1) and reaction timer panel training with gap scenario (P2); Entrainment therapy, audiovisual feedback synchronised with bilateral hand clapping; Spinal adjustments addressing identified segmental dysfunction; Oculomotor home exercises: vergence card, horizon to thumb tracking (P2), anti-saccade training using an iPad App (P1); Repetitive Peripheral Somatosensory Evoked Potential (RPSEP) stimulation of four Trigeminal (CN V) nerve locations using a peripheral nerve stimulator, one minute per location (P2); Dietary and supplemental adjuncts discussed for P2 (1, 2, 3): ketogenic diet as neuro-inflammatory mitigation. P1 completed 45 treatment sessions over 16 months. P2 completed 42 treatment sessions over 10 months.
Outcomes: P1 improved objectively; post-treatment measures rose; returned to full-time electrician with no relapse after four years. P2 substantially advanced professionally.
Conclusion: These cases show chronically symptomatic PPCS patients can achieve neurophysiological gains and employment after individualised multimodal rehab; objective saccadometry and posturography changes align with return to work, including vocational reorientation.
Author keywords: Chiropractic; post concussion syndrome; PPCS; case series; return to work; vestibular rehabilitation; sensory motor integration; spinal manipulation; multi axis rotation.
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