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Acoustic Neuroma/Vestibular Nerve Tumor

HistoryA.C. is a 44 year old male who came to The Center for Balance with a diagnosis of surgical Acoustic neuroma removal on the left side. Acoustic Neuroma removal was approximately 1 month ago. Patient is employed as a machine operator and enjoys social activities and hiking. Patient complains of dizziness 7-8/10 intensity during activities of daily living (10 being severe dizziness, 0 being no dizziness), and fear of falling 5/10 (10 being a high fear of falling, 0 no fear of falling). Patient states his dizziness is a feeling of disorientation, “like an earthquake”. Patient complains of dizziness and unable to control balance when moving his head, reading the computer, ambulating with head movements, turning, and being in crowds. Patient past medical history unremarkable.

Examination Patient demonstrated positive vestibular ocular reflex testing causing dizziness when moving his head and eyes, and imbalance while ambulating. Patient demonstrated positive oculomotor testing for vestibular deficits. Patient static/BERG balance test 48/56 moderate deficit (36/56 severe deficit); dynamic balance/dynamic gait index score was 15/24 moderate deficit (13/24 severe deficit); timed up go test 16 seconds moderate deficit (10 seconds or less is normal).

AssessmentPatient demonstrating dizziness and fear of falling limiting his ability to perform safe independent activities of daily living and work. Patient demonstrating decreased safe activities of daily living secondary to balance deficits and dizziness brought on by the lack of vestibular input from the left side. Patient activity level has decreased since surgery.

TreatmentPatient underwent an individualized functional vestibular and balance training program including vestibular adaptation exercises, functional static and dynamic balance exercises, fall prevention program, Tai Chi, and patient education. Patient was also instructed on increasing activity and endurance levels by getting out of the house for social activities as tolerated (shopping, visiting friends and family, walking his dog in the neighborhood).

Results: Upon discharge from therapy, patient was experiencing minimal dizziness, he was able to function without dizziness or balance deficits. Patient had no fear of falling during activities of daily living. Static balance score was 56/56, dynamic balance score was 24/24, timed up and got test 9 seconds. Patient was discharged from physical therapy with instructions to continue increasing activity levels. Patient was also cleared to return to work.