History: J.J. is a 48 year old male who came to The Center for Balance with a diagnosis of Meniere’s disease. Patient complains of dizziness/vertigo attacks, and imbalance limiting activities of daily living. Patient also complains of hearing loss and ringing in the left ear. Patient is employed as an information technologist and enjoys flying, activities in and around the house, and working out. Patient describes his dizziness as a feeling of floating, being on a boat, and wooziness, with episodic vertigo (room spinning). Patient states dizziness increases with head movements while walking and turning, working on the computer/reading, walking down aisles at the store, and while driving. Patient states his symptoms of imbalance increase while ambulating with head movements, turning, bending, reaching, and walking down hallways at work and aisles in stores. Patient complains of dizziness intensity 7-8/10 (10 being severe dizziness, 0 being no dizziness), and fear of falling during activities and work 9/10 (10 being a high fear of falling, 0 no fear of falling). Patient stated he fell ambulating while looking up 2 days prior to his initial assessment. Patient complains of being unable to, “do the things I want to do without having to think about getting dizzy and being off balance, my equilibrium is off”. Patient past medical history is negative for a significant role in present symptoms.
Examination: Patient demonstrated positive oculomotor testing indicating vestibular deficits while moving head and eyes during activities. Patient static balance/BERG test score was 50/56 mild deficit (36/56 severe deficit); dynamic balance/dynamic gait index score was 16/24 for a moderate deficit (13/24 severe deficit); timed up go test 19 seconds for a moderate deficit (10 seconds or less is normal). Patient demonstrated significant balance disruptions while ambulating with head movements.
Assessment: Patient demonstrating dizziness and imbalance decreasing his ability to perform independent work and activities of daily living. Patient demonstrating positive vestibular (inner ear deficits) secondary to Meniere’s disease. Patient also at risk of falling during dynamic activities especially walking, turning, and going up and down steps.
Treatment: Patient underwent an individualized functional vestibular and balance training program including vestibular adaptation exercises, functional static and dynamic balance exercises, fall prevention program, patient education, and functional gait balance exercises.
Results: On the patients last visit, all long term treatment goals were met. Patient able to perform all daily activities without dizziness or fear of falling. Static balance score was 56/56, dynamic balance scores 24/24, and timed up and go testing 9 seconds. Patient was discharged from physical therapy and instructed to continue his home exercises as needed.