1. Vestibular Rehabilitation facilitates improvements in reading and visual deficits post mild traumatic brain injury: A case study. By Karen Stevens, Hallamshire Physiotherapy Clinic, Sheffield. Case history: A 21 year old male student was referred for Vestibular Rehabilitation (VR) after sustaining localised brainstem damage during a professional kick boxing match three years prior. Presented with vertigo with fast head movements, visual difficulties when switching from near to far visual tasks (e.g. in lectures), problems visually tracking objects (e.g. playing football), poor concentration especially when reading, and motion sensitivity. Minimal anxiety related to his symptoms was detected. Some avoidant behaviour was identified. He engaged with the majority of functional activities and had implemented some useful strategies to cope with his deficits. Treatment choices : Goal = Improve visual tracking and stability.Goal = To reduce motion sensitivity Gaze Stabilisation exercises: X1/X2 viewing Eye-head to target Initially in sitting then standing. 1 minute each exercise, 4-5 times per day Progressions: Increasing distance from target Reducing base of support Unstable base Target placed on a visually busy background e.g. window Dual task e.g. counting backwards 4 treatment sessions over three month period Optokinetic Stimulation video Watching in sitting progressed to more challenging balance positions. Outcomes: Vestibular Rehab Benefits questionnaire (VRBQ): VRBQ(Morris et al 2009) Head thrust test no longer positive https://www.youtube.com/watch?v=kAPtu1WTHYc Literature review: Several studies support the use of VRT in mild TBI (Gurley et al 2013, Gottshall 2011, Gurr et al 2001). Descriptive studies. Support for customized VRT with specialised staff (Aligene et al 2013, Gurley et al 2013) Need to consider all potential consequences of mild TBI (Gottshall 2011) Useful article (Cohen 2013) reviewing role of Neuro-optometrist in visual-vestibular dysfunction. Reflection: VRBQ helped to focus the VRT program and drew attention to areas such as activity avoidance that the client did not openly report. YouTube video added a different dimension to home exercise program and helped motivation. Use of a specific reading outcome measure could have been useful - ? Any standardized measures, ? Timed section of text Conclusion Although functioning at a high level with self generated coping strategies, the client benefitted from VRT. He made quick gains requiring a low number of sessions. The literature suggest VRT is beneficial in MTBI and this case study supports this. References: Aligene, K. and Lin, E. (2013) Vestibular and balance treatment of the concussed athlete. Neurorehabilitation 32 543-553 Gottshall,K. (2011) Vestibular rehabilitation after mild traumatic brain injury with vestibular pathology. 29 167-171 Gurr, B. and Moffat, N. (2001) Psychological consequences of vertigo and the effectiveness of vestibular rehabilitation for brain injury patients. Brain injury 15(5) 387- 400 Morris, A. Lutman, M. Yardley, L. (2009) Measuring outcome from vestibular rehabilitation, part ii: refinement and validation of a new self-report measure. International Journal of Audiology 48: 24-37 Subjective changes: Able to text and walk concurrently Able to sit towards the back of the lecture theatre Can concentrate for longer on reading Objective markers post treatment: Smooth pursuit normal Timed unsupported stand feet together with eyes increased from 10 seconds to 45 seconds Fudeka’s stepping test – returned to normal Head thrust no longer positive Key: Blue = pre-treatment Yellow = post treatment VBRQ is a self reported outcome measure. It includes symptoms and quality of life subscales. Threshold for clinically meaningful change are available.