Stroke TIAs

History: M.S. is a 79 year old female who came to The Center for Balance with complaints of dizziness, balance deficits, and a history of multiple falls after suffering from a stroke and multiple TIA’s. Patient complains of dizziness, “It feels like I can’t focus, I have waves of imbalance and wooziness, I have to stay still”. Patient states her dizziness and balance problems increase with head movements, walking between and around objects, in crowds, using stairs, shopping, and going out to lunch and dinner. Patient further states, “I just stay at home now, I am so afraid of falling”. Patient states her dizziness intensity during activities is 8/10 (10 being severe dizziness, 0 being no dizziness) and a fear of falling 8/10 (10 being a high fear of falling, 0 no fear of falling). Patient without any complaints of paralysis of the extremities.

Examination: Patient demonstrated positive oculomotor testing (positive dizziness because of deficits in her vestibular system). Patient static balance BERG test 41/56 (36/56 severe deficits); dynamic gait index/dynamic balance test score 16/24 (13/24 severe deficit); Timed up and go testing 17 seconds moderate deficit (10 seconds or less is normal). Patient also demonstrating slow unsteady gait.

Assessment: Patient demonstrating high dizziness and fear of falling intensity limiting activities. Patient demonstrating decreased functional static and dynamic balance during activities of daily living preventing independence in and out of the home. Patient at increased risk of falling during activities, demonstrating unsafe balance. Patient endurance has decreased significantly and patient spends most of her time at home, “I just sit around”.

Treatment: Patient underwent an individualized functional vestibular (inner ear) and balance training program including vestibular strengthening exercises, functional static and dynamic balance exercises, fall prevention program, trunk/CORE strengthening exercises, and patient education. Patient also performed movement initiation and awareness exercises through a Tai Chi functional exercises program.

Results: At the time of discharge from physical therapy M.S. was demonstrating no dizziness or fear of falling during daily activities. Patient balance testing scores goals have been met; static balance final score 52/56 (goal 52/56), dynamic balance final score 22/24 (goal 22/24), timed up and go score 10 seconds (goal 10 seconds or less). Patient returned to being able to shop, go to dinner, and enjoy her grandchildren.