Dizziness and Imbalance in the Elderly

History: N.D. is a 75 year old male who came to The Center for Balance with a diagnosis of dizziness and imbalance during activities of daily living. Cause of present symptoms; undetermined, "It just started and worsened over the months". Patient past medical history includes asthma, arthritis bilateral hips and knees, cervical vertebral foramen narrowing. Patient states his symptoms began approximately 1 year ago and have been gradually getting worse. Patient has had multiple falls in the last year and is concerned with injuring himself. Patient is retired and enjoys working on his computer, yard work, general activities around the house, going to dinner. Patient complains of having difficulties walking up and down stairs or inclines, walking in the yard, walking over and around obstacles, yard work involving bending, and shopping. “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 8/10 (10 being severe dizziness, 0 being no dizziness), fear of falling 7/10 (10 being a high fear of falling, 0 no fear of falling).

Examination: Patient demonstrated positive oculomotor testing indicating vestibular (inner ear) weakeness. Patient static balance/BERG test score was 43/56 moderate deficit (36/56 or less severe deficit); dynamic balance/dynamic gait index score was 15/24 moderate deficit (13/24 or less severe deficit); timed up go test 21 seconds moderate deficit (10 seconds or less is normal).

Assessment: Patient demonstrating dizziness and fear of falling limiting his ability to comfortably perform independent activities of daily living. Patient demonstrating decreased safe activities of daily living secondary to balance deficits. Patient overall activity level has declined since his symptoms began.

Treatment: Patient underwent an individualized functional vestibular and balance training program including vestibular adaptation exercises, functional static and dynamic balance exercises, core strengthening program, endurance training, and fall safety awareness program.

Results: At the time of discharge from physical therapy N.D. was demonstrating no dizziness or fear of falling during daily activities. Patient balance testing scores goals have been met; static balance final score 54/56 (goal 52/56), dynamic balance final score 23/24 (goal 22/24), timed up and go score 9 seconds (goal 10 seconds or less). Patient returned to his prior level of safe activities of daily living without dizziness or balance deficits.