Falling risk: Case presentation

Some risk factors are obviously unavoidable – including age and gender. To limit your falls risk follow the four tips: 

• Unsafe Environments - home health 
• Poor eyes and bad vision 
• PolyPharmacy - too many drugs 
• Poor balance

Case Presentation 

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 imbalance as she was the primary carer for her Dementing husband.On inspection, this lady found it difficult to manoeuvre around the consulting room. In particular, her turn and look gait was ataxic. 

• A Sit to Stand (STS) test exceeded 45 seconds. She was not able to complete this test with closed eyes 

• Romberg’s test was positive;

 • Fukuda’s test (Marching test on one spot) she turned to left greater than 30 degrees at five steps;

 • Visio-motor response was hypokinetic;

 • Vestibule-Ocular Reflex (VOR) test reduced to left; 

• Computerised Dynamic Posturography (CDP) confidence for Test of Balance (TOB) at 66 (average 22); 

• Modified Falls Efficacy Scale (MFES) measured at 82% (high risk).

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: 

1. To improve this lady’s vestibular system and ultimately reduce her fall risk 
2. To improve her quality of life. 

This plan is achieved by supporting her spino-vestibular, olivo-vestibular and ponto-vestibular pathways.Over eight weeks, the Practitioner implemented Vestibular Rehabilitation Therapy (VRT).The therapy was performed twice daily for 30 minutes, with supervision thrice weekly. 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.

Clinical Outcomes 

A full evaluation was completed at weeks two, four and eight. At week two, the patient had improved MFES to 59 and a TOB confidence scale of 42. The patient improved on the MFES 21 and TOB confidence scales 35 at week eight. 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 could walk along the beach without fearing 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. 

Balance and Dizziness Clinic at Brainstorm