History: E.R. is a 13-year-old female who came to The Center for Balance complaining of dizziness and balance deficits during activities of daily living and school after suffering a concussion playing soccer secondary to being struck in the head, positive for some loss of consciousness. E.R. is in the seventh grade and has been unable to go to school because of her symptoms since the initial concussion injury on September 9th, 2016; her initial visit to The Center for Balance was on October 14th 2016. E.R.’s mother stated she passed all concussion protocols by her orthopedist and athletic Trainor, but complained of dizziness, inability to read, and balance problems. E.R.’s mother explained that a friend of their family had a high school athlete who suffered a concussion playing football and had similar symptoms and after coming to The Center for Balance his symptoms were gone and he has returned to prior activities and sports without dizziness or balance problems. E.R. complained of dizziness intensity 5/10 (1o being severe dizziness, 0 being no dizziness) during activities of daily living. Patient states dizziness increases with head and eye movements, reading her computer, in crowded areas. Patient also stated she was unable to attend school because of dizziness and balance issues walking the halls between classes, concentrating in class, reading, and unable to partake in physical activities and sports. Along with her dizziness and balance issues, E.R. complained of neck pain and stiffness and being unable to turn or bend her head.

Examination: Patient demonstrating positive vestibular ocular reflex and smooth pursuit testing indicating dizziness because of the concussive incident. Patient also demonstrated positive trunk torsion smooth pursuit testing indicating the presence of cervicogenic dizziness (dizziness due to neck pain and stiffness). Patient static balance BERG testing 46/56 (36/56 moderate deficits), dynamic balance/dynamic gait index 18/24 (13/24 moderate deficit), patient demonstrating slow deliberate gait without trunk rotation, arm swinging, and head movements.

Assessment: Patient demonstrating dizziness and balance deficits limiting activities of daily living, sports, and school (unable to attend).

Treatment: E.R. underwent our post concussion cervicogenic dizziness protocol involving visual tracking exercises, functional static and dynamic balance exercises, manual neck soft tissues techniques, manual traction techniques, neck range of motion exercises.

Results: At the time of discharge from physical therapy E.R. could return to school and sports  full time without dizziness or balance problems. Patient static BERG balance test 56/56 (goal 56/56), dynamic gait index 24/24 (goal 24/24), negative cervicogenic dizziness testing. All patient goals were met at time of discharge. Two months after discharge from physical therapy E.R.’s mother called The Center for Balance to say E.R. has, “returned to her old self and was able to go to Australia for 3 weeks on a student exchange through her school”.