Case presentation
The 48-year-old female patient presented with a history of severe constant nausea and vertigo. The symptoms were constant over 25 years with an increase in severity over a recent three-year period. She had to be admitted to hospital numerous times and was treated with anti-nausea medication. She was treated with anti-depressive and mild tranquillisers for right limb paraesthesia. Her previous blood pathology, imaging studies and nerve conduction tests were unequivocal. Currently the nausea and vertigo was impairing her social functioning and ADL at work and home.
Treatment Plan
Vertigo does not have pre-detection for age or gender. Vestibular function tests identified that this patient has sustained a vestibular hypo-function (ICD H81.9). Some key findings include;
- Dizziness Handicap Inventory (DHI) score-56% (mild dizziness)
- Modified Falls Efficiency Score (MFES)- 60% (poor efficiency)
- Hypokinetic vestibular ocular reflex
- Hypo metric saccades
- Dynamic Visual Acuity (DVA)test-unable to perform horizontal activity
- Left ataxic dynamic gait with torsional head
- Computerise Digital Posturography (CDP)- low balance confidence score
Giving this presentation, the practitioners therapeutic goals were:
- To improve this patients impairment rating for vertigo and dizziness.
- To generally improve the balance control.
- To actively support skills to better adapt her disability in a social setting.
Clinical Outcome
After 10 weeks of therapy, the patient had improved with no further nausea or vertigo. The predominant treatment involved Vestibular Rehabilitation Therapy (VRT). This approach involves acombination of head and/or eye activities to support the balance function. VRT is a safe therapy enabling habituation of vestibular control.
She had significant functional improvements with normal outcome measures (DHI score, MFES, DVA test and Balance confidence score) and VOR function was full and complete. This patient had a complete resolution of the vestibular hypo-function. She no longer had a disability and has returned to full ADL.
