A Novel Approach to Integrative Concussion Rehabilitation: A Pragmatic Study

Purpose: The purpose of this study is to evaluate the effectiveness of the novel Ziaks Integrative Neurological Concussion (ZINC) Protocol in evaluating and treating persistent post-concussion symptoms. Methods: Individuals with concussion were systematically evaluated for neurological impairments and subsequently received six modules of integrative and progressive therapies. Treatment addressed motor function impairment, oculomotor and binocular vision deficits, and central vestibular deficits while incorporating postural stability, dual task and cognitive loading skills and providing instruction in cardiovascular exercise to promote autonomic stability. Results: Of 30 patients, 15 completed all 6 protocol modules for inclusion in data analysis. Mean treatment duration was 6.6 (SD±.99) visits over 69.53 days (SD±21.92). The Post-Concussion Symptom Scale and Dizziness Handicap Inventory outcomes from pre- to post-treatment achieved clinical and statistical significance. Statistical significance was achieved for the Brain Injury Vision Symptom Survey, Brock String near point of convergence, King Devick and the novel binocular vision screening tool. Conclusions: A structured, integrative, and progressive rehabilitation program addressing the vestibulo-oculomotor and motor function domains of concussion may be effective in the management of persistent post-concussion symptoms. Impact Statement: This study details one potential comprehensive and sequential method to integrate the neurological domains of concussion rehabilitation while screening for impairments in the physical domains. There is a gap in knowledge regarding the most effective timing, sequencing, and implementation of intervention methods across the 4 concussion domains. This study provides the groundwork for future research to establish treatment protocols aimed to efficiently reduce symptoms associated with persistent post-concussion symptoms.