History: M.R.is a 61 year old female was referred to The Center for Balance with complaints of dizziness and balance problems and a history of multiple falls after treatment for lung cancer (chemotherapy and radiation treatments). M.R. describes her present symptoms of dizziness as being unable to focus and she wants, “to be able to stand without holding on and to walk without a cane”. M.R. is employed as a CPA but is unable to work because her dizziness is increased with head and eye movements, unable to read her computer, and feels unsafe ambulating, “I can’t even get to work”. M.R. also complains of fatigue, poor endurance, and being unable to perform simple activities of daily living. Patient complained of dizziness intensity 10/10 (10 being severe dizziness, 0 being no dizziness) during activities and a fear of falling 8/10 (10 being a high fear of falling, 0 being no fear of falling).
Examination: Patient demonstrating positive VOR and smooth pursuit testing (dizziness caused by vestibular/inner ear deficits because of chemo/radiation treatments). Patient static balance BERG score 38/56 (36/56 severe deficits), dynamic balance/dynamic gait index 11/24 (13/24 severs deficits); timed up and go test, patient was unable to stand without use of upper extremities to stand independently (10 seconds or less is normal without use of upper extremities to stand). Patient demonstrating a slow unsteady and unsafe gait. Patient is at a high risk of falling during activities of daily living.
Assessment: Patient demonstrating severs dizziness, fear of falling and balance deficits limiting activities. Patient also demonstrating poor endurance and unsafe activates, as well as, not being able to work.
Treatment: M.R. underwent an individualized treatment program consisting of vestibular strengthening exercises, visual tracking exercises, static and dynamic functional balance exercises, gait balance exercises, obstacle negotiation exercises, and endurance training exercises.
Results: Upon discharge from physical therapy, M.R. could perform independent activities without suffering from dizziness or a fear of falling, BERG balance score 50/56 (goal 52/56), dynamic gait index 22/24 (goal 22/24), timed up and go test 12 seconds (goal 10 seconds or less). Patient had met 95% of her goals and felt she was able to return to her prior level of activities, stating, “I am good to go”.