1. Case Studies

2. Case Study #1
25 year old female with no significant past medical history now has a new onset of dizziness when lying down and when sitting up, occurring mostly when her head is turned to the right side. When performing the Dix Hallpike maneuver to the right side, the patient demonstrates brief, upbeating, right torsional nystagmus, lasting for 12 seconds. She does not have a positive test to the left side.

3. Case Study #1 Questions What is the treatment diagnosis?
What is your treatment plan?
What instructions would you provide after treatment?

4. Case Study #2
50 year old male with a cardiac history presents with a recent onset of severe dizziness and nausea lasting for several days. He was admitted to the hospital for observation and testing. He had a battery of tests including a cardiac workup, neurologic tests including MRI and ECG, and blood work. All tests were negative and the patient was cleared for discharge after a few days. He now presents at your office with complaints of less dizziness and nausea, but reports feeling like he is rocking and losing his balance. Oculomotor exam is as follows: negative neuro screen, positive head thrust test to left, positive head shake test with right beating nystagmus, abnormal DVA (0.4).

5. Case study #2 questions What is the treatment diagnosis?
What are some treatment options for this patient?
What are some exercises for a home exercise program?

6. Case study #3
75 year old female with significant past medical history including OA, CVA and cardiac now presents to your office with complaints of loss of balance and frequent falls. She was referred by her neurologist after being recently diagnosed with neuropathy. Her evaluation revealed the following: Berg Balance Scale: 44, Dynamic Gait Index: 17 without using an assistive device, Sensory Organization Test: 60 with loss of balance in conditions 4,5 and 6, lower extremity weakness bilaterally to ankles, quads and hip extensors. The patient’s goal is to regain balance as close to normal as she can.

7. Case study #3 questions
Is an assistive device recommended for this patient?
What are some treatment options for this patient?
What are some long term goals for this patient?

8. Case study #4
35 year old male s/p fall at work was diagnosed with a concussion. The patient reports headache, dizziness and nausea occurring 5 days after the fall and was referred by physiatry for vestibular therapy. Upon evaluation the oculomotor exam and neuro screen were unremarkable. Dix Hallpike was negative bilaterally with no significant increase in symptoms. Dynamic Gait Index score was 15 with exaggerated, atypical ataxic pattern, however, no fall observed. Berg Balance Scale was 28. atypically low for this patient’s overall function. You suspect that the patient may demonstrate aphysiologic responses during this test.

9. Case study #4 questions Would you treat this patient?
What are your goals for the next 4 weeks?