History

BA is a 74-year-old male who came to The Center for Balance with complaints of dizziness and balance deficits after falling at home and hitting his head on the stone edge of the fireplace in his family room. After being rushed to the emergency room, BA was diagnosed with a subdural hematoma, (bleeding on the brain surface below the skull). After spending a week in the hospital, BA was discharged but had symptoms of dizziness and balance problems. “It is like my feet are on waves, I used to be able to rock climb and hike, now I can’t even walk”. “I am afraid people think I’m drunk when I walk, and I don’t even drink”. “I feel light headed and I need help with my dizziness”. Patient dizziness intensity during activities 8/10 (10 being severe dizziness, 0 being no dizziness), that increases with head and eye movements, reading, walking, turning, and shopping. Patient fear of falling during activities 5/10 intensity (10 being a high fear of falling, 0 no fear of falling).

Examination

Patient demonstrated positive oculomotor testing indicating vestibular (inner ear) deficits. Patient static balance/BERG test score was 40/56 moderate deficit; dynamic balance/dynamic gait index score was 13/24 severe deficit; timed up go test 21 seconds severe deficit. Patient also demonstrated positive cervicogenic dizziness (dizziness due to tight neck muscles and decreased ability to move head through full range).
Assessment: Patient demonstrating the inability to perform safe independent activities of daily living due to dizziness and balance deficits from his traumatic brain injury resulting from a fall. Patient goals are to, “get back to being able to do things by myself and not rely on others for help, and to get back to my bee hives”.

Treatment

Patient underwent an individualized functional vestibular and balance training program including vestibular adaptation exercises, functional static and dynamic balance exercises, gait balance exercises, core strengthening program, endurance training, manual neck muscle treatment, and fall safety awareness program.
Results: At the time of discharge from physical therapy BA could perform all activities of daily living without dizziness or fear of falling. Patient balance testing scores goals have been met; static balance final score 53/56 (goal 52/56), dynamic balance final score 24/24 (goal 22/24), timed up and go score 9 seconds (goal 10 seconds or less). Patient could return to his prior level of safe activities of daily living. In BA’s own words, “I can’t thank you guys enough, I don’t know how I would have gotten over all this, I will tell all my friends”. BA has returned tending to his honey bees and enjoys helping other bee enthusiasts in the area.

Summary

Traumatic brain injuries/concussions due to falls in the elderly can have devastating consequences. One does not even have to strike their head during a fall to suffer these symptoms. If someone suffers from dizziness and feels they are off balance, a risk of fall assessment is essential to address these symptoms and prevent a fall from happening.