An accurate identification of the balance disorder is paramount with prevention of falls. The purpose of balance function testing is to determine the site and degree of damage, to gather information regarding general functional abilities and evaluate the level of compensations. This permits a specific rehabilitation to be formulated.
Furthermore, to reduce older people from falling, the following has been shown effective:
A 65 year old female patient presented with a history of frequent falls and disequilibrium. Her general health was unremarkable otherwise. She was not experiencing vertigo and had no hearing deficiency. She expressed concerns about her increased disequilibrium as she was the primary carer for her husband who suffered Dementia.
On inspection this lady found it difficult to manoeuvre around the consulting room. In particular, her turn and look gait was ataxic.
Note the plot projection of centre of mass on September 2012 study demonstrates a greater anterior-posterior (A-P) and medial-lateral (M-L) migration, when compared to the November 2012 study. This indicates improved stability confidence while erect.
Treatment and Therapeutic Plan
From the assessment it appears this lady had a vestibular hypo-function on the left.
Given this presentation and findings, the Practitioner’s therapeutic goals were:
This plan is achieved by supporting her spino-vestibular, olivo-vestibular and ponto-vestibular pathways.
Over an eight week period the practitioner implemented Vestibular Rehabilitation Therapy (VRT).
The therapy was performed twice daily for 30 minutes, with supervision three times per week. Sessions were modified and progressed through the program. The use of Virtual Reality vestibular training was implemented in the last three weeks of the program.
A full evaluation was completed at weeks two, four and eight. At week two, the patient had improved MFES to 59 and TOB confidence scale 42. At week eight the patient further improved MFES 21 and TOB confidence scale 35. The patient was able to complete a 10 metre walk test with head turning. She was able to manoeuvre through a tactile organised obstacle course. Her visio-motor activity was full and complete. The patient stated that she was able to walk along the beach without the fear of falling. Her fear of falling is only currently limited to descending stairs – which is improving.
Overall her neurological health has improved so dramatically, she is now taking vacations and excursions away.