Parkinson’s Disease

History: M.P. is a 70 year old female who came to The Center for Balance for balance deficits as a result of Parkinson’s disease. Patient initial diagnosis of Parkinson’s disease was 7 years ago. Patient is retired and enjoys general activities around the house and yard, singing, and going to dinner. Patient complains of difficulty with balance during all upright activities; walking, turning, reaching. Patient states she has trouble controlling her legs and trunk, “they do not want to move, I get stuck”. Patient also states she has had a history of falling due to her symptoms. Patient complains of dizziness 4-5/10 (10 being severe dizziness, 0 being no dizziness), fear of falling 5/10 (10 being a high fear of falling, 0 no fear of falling). Patient complains of dizziness, “as a fuzzy feeling, my head and legs do not know what they are doing”.

Examination: Patient demonstrated negative saccadic testing, positive smooth pursuit and vestibular ocular testing indicating vestibular (inner ear deficits). Patient static balance/BERG test score was 42/56 moderate deficit (36/56 severe deficit); dynamic balance/dynamic gait index score was 17/24 moderate deficit (13/24 severe deficit); timed up go test 15 seconds for a moderate deficit (10 seconds or less is normal). Patient demonstrated a slow, shortened step length gait.

Assessment: Patient demonstrating decreased functional balance and gait during activities of daily living. Patient has difficulty with functional transitional movements, gait initiation, and freezing in place. Patient suffers from dizziness decreasing ambulation and turning with head initiation.

Treatment: Patient underwent an individualized functional vestibular and balance training program including vestibular adaptation exercises, functional static and dynamic balance exercises, fall prevention program, and patient education. Patient also performed movement initiation and awareness exercises through our Tai Chi functional exercise program.

Results: Upon discharge from physical therapy, patient was experiencing no dizziness or fear of falling during activities of daily living. Patient balance goals were met; Berg 52/56, DGI 22/24, timed up and go testing 9 seconds (goal 10 seconds or less). Patient was discharged from therapy with instructions to continue her home exercise program and to augment treatment with exercising (water aerobics, senior exercise program, general fitness activities.