Pump Head/Post Perfusion

History: B.W. is a 79 year old male referred to The Center for Balance with complaints of dizziness, balance problems, and 2 falls in the last 3-4 months. B.W. stated his symptoms began after having bypass surgery four months ago. Patient symptoms consist of a feeling of lightheadedness while moving his head, reading, walking with head movements, shopping in stores with bright lights, and walking on uneven surfaces. Patient describes his symptoms as, “a feeling of wooziness and light headedness, I cant control my balance, I think people think I am drunk, I could never pass a DUI test, I basically do nothing”. Patient complains of dizziness intensity of 7/10 (10 being severe, o being no dizziness). Patient further states his fear of falling during activities of daily living is 6/10 (10 high fear of falling, 0 no fear of falling). B.W. states he is afraid to go out by himself, feels he is a burden to his family, and not the person he used to be.

Examination: Patient demonstrated positive VOR testing (dizziness caused by head and eye  movements). Patient static balance BERG testing 40/56 (36/56 severe deficits); dynamic balance testing/dynamic gait index 14/24 (13/24 severe deficit); timed up and go test 16 seconds (10 seconds or less is normal). Patient demonstrating severe gait disruptions amb. with head movements, walking on uneven surfaces, walking around and over obstacles.

Assessment: B.W. is demonstrating dizziness and a fear of falling limiting activities of daily living. Patient functional static and dynamic is poor putting patient t a high fall risk. Patient has significantly decreased his activity levels and is afraid to leave home alone.

Treatment: Patient treatment consisted of custom dizziness exercises, functional static and dynamic balance exercises, CORE strengthening exercises, gait balance exercises, and endurance training.

Results: At the time of discharge from physical therapy B.W. was able to perform ADL’s without dizziness or fear of falling during daily activities. Static balance BERG score 53/56 (goal 52/56), dynamic balance score dynamic gait index 22/24 (goal 22/24), timed up and go score 8 seconds (goal 10 seconds or less). B.W. states he is able to do things by himself, “I don’t have to bother my wife any more”.

Acoustic Neuroma/Vestibular Nerve Tumor

History: A.C. is a 44 year old male who came to The Center for Balance with a diagnosis of surgical Acoustic neuroma removal on the left side. Acoustic Neuroma removal was approximately 1 month ago. Patient is employed as a machine operator and enjoys social activities and hiking. Patient complains of dizziness 7-8/10 intensity during activities of daily living (10 being severe dizziness, 0 being no dizziness), and fear of falling 5/10 (10 being a high fear of falling, 0 no fear of falling). Patient states his dizziness is a feeling of disorientation, “like an earthquake”. Patient complains of dizziness and unable to control balance when moving his head, reading the computer, ambulating with head movements, turning, and being in crowds. Patient past medical history unremarkable.

Examination:  Patient demonstrated positive vestibular ocular reflex testing causing dizziness when moving his head and eyes, and imbalance while ambulating. Patient demonstrated positive oculomotor testing for vestibular deficits. Patient static/BERG balance test 48/56 moderate deficit (36/56 severe deficit); dynamic balance/dynamic gait index score was 15/24 moderate deficit (13/24 severe deficit); timed up go test 16 seconds moderate deficit (10 seconds or less is normal).

Assessment: Patient demonstrating dizziness and fear of falling limiting his ability to perform safe independent activities of daily living and work. Patient demonstrating decreased safe activities of daily living secondary to balance deficits and dizziness brought on by the lack of vestibular input from the left side. Patient activity level has decreased since surgery.

Treatment: Patient underwent an individualized functional vestibular and balance training program including vestibular adaptation exercises, functional static and dynamic balance exercises, fall prevention program, Tai Chi, and patient education. Patient was also instructed on increasing activity and endurance levels by getting out of the house for social activities as tolerated (shopping, visiting friends and family, walking his dog in the neighborhood).

Results: Upon discharge from therapy, patient was experiencing minimal dizziness, he was able to function without dizziness or balance deficits. Patient had no fear of falling during activities of daily living. Static balance score was 56/56, dynamic balance score was 24/24, timed up and got test 9 seconds. Patient was discharged from physical therapy with instructions to continue increasing activity levels. Patient was also cleared to return to work.

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.

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.

Cancer/Oncology

History: M.R.is a 61 year old female was referred to The Center for Balance with complaints of dizziness and balance problems and a history of multiple falls after treatment for lung cancer (chemotherapy and radiation treatments). M.R. describes her present symptoms of dizziness as being unable to focus and she wants, “to be able to stand without holding on and to walk without a cane”. M.R. is employed as a CPA but is unable to work because her dizziness is increased with head and eye movements, unable to read her computer, and feels unsafe ambulating, “I can’t even get to work”. M.R. also complains of fatigue, poor endurance, and being unable to perform simple activities of daily living. Patient complained of dizziness intensity 10/10 (10 being severe dizziness, 0 being no dizziness) during activities and a fear of falling 8/10 (10 being a high fear of falling, 0 being no fear of falling).

Examination: Patient demonstrating positive VOR and smooth pursuit testing (dizziness caused by vestibular/inner ear deficits because of chemo/radiation treatments). Patient static balance BERG score 38/56 (36/56 severe deficits), dynamic balance/dynamic gait index 11/24 (13/24 severs deficits); timed up and go test, patient was unable to stand without use of upper extremities to stand independently (10 seconds or less is normal without use of  upper extremities to stand). Patient demonstrating a slow unsteady and unsafe gait. Patient is at a high risk of falling during activities of daily living.

Assessment: Patient demonstrating severe dizziness, fear of falling and balance deficits limiting activities and work, unable to drive. Patient also demonstrating poor endurance and unsafe activates, as well as, not being able to work.

Treatment: M.R. underwent an individualized treatment program consisting of vestibular strengthening exercises, visual tracking exercises, static and dynamic functional balance exercises, gait balance exercises, obstacle negotiation exercises, and  endurance training exercises.

Results: Upon discharge from physical therapy, M.R. could perform independent activities without suffering from dizziness or a fear of falling, BERG balance score 54/56 (goal 52/56), dynamic gait index 22/24 (goal 22/24), timed up and go test 12 seconds (goal 10 seconds or less). Patient had met 100% of her goals and she was able to return to her prior level of activities, stating, “I am good to go”.

Concussion

History: E.R. is a 13-year-old female who came to The Center for Balance complaining of dizziness and balance deficits during activities of daily living and school after suffering a concussion playing soccer secondary to being struck in the head, positive for some loss of consciousness. E.R. is in the seventh grade and has been unable to go to school because of her symptoms since the initial concussion injury on September 9th, 2016; her initial visit to The Center for Balance was on October 14th 2016. E.R.’s mother stated she passed all concussion protocols by her orthopedist and athletic Trainor, but complained of dizziness, inability to read, and balance problems. E.R.’s mother explained that a friend of their family had a high school athlete who suffered a concussion playing football and had similar symptoms and after coming to The Center for Balance his symptoms were gone and he has returned to prior activities and sports without dizziness or balance problems. E.R. complained of dizziness intensity 5/10 (1o being severe dizziness, 0 being no dizziness) during activities of daily living. Patient states dizziness increases with head and eye movements, reading her computer, in crowded areas. Patient also stated she was unable to attend school because of dizziness and balance issues walking the halls between classes, concentrating in class, reading, and unable to partake in physical activities and sports. Along with her dizziness and balance issues, E.R. complained of neck pain and stiffness and being unable to turn or bend her head.

Examination: Patient demonstrating positive vestibular ocular reflex and smooth pursuit testing indicating dizziness because of the concussive incident. Patient also demonstrated positive trunk torsion smooth pursuit testing indicating the presence of cervicogenic dizziness (dizziness due to neck pain and stiffness). Patient static balance BERG testing 46/56 (36/56 moderate deficits), dynamic balance/dynamic gait index 18/24 (13/24 moderate deficit), patient demonstrating slow deliberate gait without trunk rotation, arm swinging, and head movements.

Assessment: Patient demonstrating dizziness and balance deficits limiting activities of daily living, sports, and school (unable to attend).

Treatment: E.R. underwent our post concussion cervicogenic dizziness protocol involving visual tracking exercises, functional static and dynamic balance exercises, manual neck soft tissues techniques, manual traction techniques, neck range of motion exercises.

Results: At the time of discharge from physical therapy E.R. could return to school and sports  full time without dizziness or balance problems. Patient static BERG balance test 56/56 (goal 56/56), dynamic gait index 24/24 (goal 24/24), negative cervicogenic dizziness testing. All patient goals were met at time of discharge. Two months after discharge from physical therapy E.R.’s mother called The Center for Balance to say E.R. has, “returned to her old self and was able to go to Australia for 3 weeks on a student exchange through her school”.

Cervicogenic (because of neck pain/stiffness) Dizziness

History: B.B. is a 56 year old female who came to The Center for Balance with complaints of dizziness and balance problems. Patient states present symptoms initially began after slipping on ice and falling backwards striking her head. Patient sustained a neck sprain/strain injury.  Patient complains of dizziness, vertigo, imbalance, and neck pain and stiffness, “It is like a whiplash injury to my neck, but I also hit my head and had a concussion”. Patient complains of dizziness with head movements, walking and turning her head, and reading her computer. Patient is presently employed in the medical field and is on her feet all day with a lot of turning, bending, and ambulating. Daily activities include; work, family outings, general activities of daily living, and working out.  Patient complains of dizziness 8/10 (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 stated her dizziness feels like, “wooziness, light headedness”, during activities moving her head and trunk.

Examination: Patient demonstrated positive oculomotor testing indicating vestibular (inner ear) deficits with eyes and head movements. Patient experiences dizziness while moving eyes to read and moving her head while focusing on an object. Patient static balance/BERG test score was 42/56 moderate deficit (36/56 severe deficit); dynamic balance/dynamic gait index score was 17/24 for moderate deficit (13/24 severe deficit); timed up go test 12 seconds moderate deficit (10 seconds or less is normal). Patient demonstrated a significant decrease in range of motion side bending and rotating her head. Patient demonstrated a positive trunk torsion smooth pursuit test for cervicogenic dizziness secondary to neck pain and stiffness.

Assessment: Patient demonstrating dizziness and imbalance secondary to post concussion and neck injury sustained in a fall (cervicogenic dizziness). Patient demonstrating decreased cervical range of motion, neck stiffness and pain, and abnormal neck biomechanics during activities of daily living. Patient demonstrating increased risk of falling during dynamic activities.

Treatment: Patient underwent an individualized functional vestibular rehab and balance training program concentrating on vestibular adaptation exercises and manual physical therapy techniques to increase cervical (neck) range of motion and to decrease muscle spasms. Treatment included neck manual traction, soft tissue mobilization and massage of the neck muscles, and range of motion and neck strengthening exercises. Patient also performed functional static and dynamic balance exercises.

Results: At the time of discharge from physical therapy, patient was demonstrating no dizziness or fear of falling during daily activities. Patient balance testing scores goals have been met; static balance final score 56/56 (goal 56/56), dynamic balance final score 24/24 (goal 22/24), timed up and go score 7 seconds (goal 10 seconds or less). Patient cervical range of motion was within normal limits, negative trunk torsion smooth pursuit testing. Patient was able to return to her prior level of activities of daily living without dizziness, imbalance, and neck pain or stiffness.

Meniere’s Disease

History: J.J. is a 48 year old male who came to The Center for Balance with a diagnosis of Meniere’s disease. Patient complains of dizziness/vertigo attacks, and imbalance limiting activities of daily living. Patient also complains of hearing loss and ringing in the left ear. Patient is employed as an information technologist and enjoys flying, activities in and around the house, and working out. Patient describes his dizziness as a feeling of floating, being on a boat, and wooziness, with episodic vertigo (room spinning). Patient states dizziness increases with head movements while walking and turning, working on the computer/reading, walking down aisles at the store, and while driving. Patient states his symptoms of imbalance increase while ambulating with head movements, turning, bending, reaching, and walking down hallways at work and aisles in stores. Patient complains of dizziness intensity 7-8/10 (10 being severe dizziness, 0 being no dizziness), and fear of falling during activities and work 9/10 (10 being a high fear of falling, 0 no fear of falling). Patient stated he fell ambulating while looking up 2 days prior to his initial assessment. Patient complains of being unable to, “do the things I want to do without having to think about getting dizzy and being off balance, my equilibrium is off”. Patient past medical history is negative for a significant role in present symptoms.

Examination: Patient demonstrated positive oculomotor testing indicating vestibular deficits while moving head and eyes during activities. Patient static balance/BERG test score was 50/56 mild deficit (36/56 severe deficit); dynamic balance/dynamic gait index score was 16/24 for a moderate deficit (13/24 severe deficit); timed up go test 19 seconds for a moderate deficit (10 seconds or less is normal). Patient demonstrated significant balance disruptions while ambulating with head movements.

Assessment: Patient demonstrating dizziness and imbalance decreasing his ability to perform independent work and activities of daily living. Patient demonstrating positive vestibular (inner ear deficits) secondary to Meniere’s disease. Patient also at risk of falling during dynamic activities especially walking, turning, and going up and down steps.

Treatment: Patient underwent an individualized functional vestibular and balance training program including vestibular adaptation exercises, functional static and dynamic balance exercises, fall prevention program, patient education, and functional gait balance exercises.

Results: On the patients last visit, all long term treatment goals were met. Patient able to perform all daily activities without dizziness or fear of falling. Static balance score was 56/56, dynamic balance scores 24/24, and timed up and go testing 9 seconds. Patient was discharged from physical therapy and instructed to continue his home exercises as needed.

Traumatic Brain Injury After a Fall

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”. “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.

Vestibular Migraine

History: J.L. is a 36 year old female that came to The Center for Balance with complaints of dizziness and balance deficits during activities of daily living and work. J.L. stated her dizziness ranges in intensity from 4-8/10 (10 being severe dizziness, 0 being no dizziness) that is aggravated by positional changes, varying lighting situations, walking in halls at school (employed as school counselor), and at the end of her work day. J.L. stated her episodes of dizziness and vertigo can last from a few minutes to a few days in length. “When my dizziness is bad I have to touch something to help with my balance”. Patient also has a history migraine related headaches, neck/head pain. J.L. also stated she has decreased her activity levels significantly since her symptoms began.

Examination: J.L. demonstrated positive vestibular ocular reflex testing for vestibular related dizziness. Patient also demonstrated decreased active range of motion of her head and neck and demonstrated limited cervical joint mechanics with stiff neck musculature. Patient also demonstrated decreased functional balance testing.

Treatment: J.L. underwent an individualized treatment program consisting of manual cervical techniques to promote proper cervical mechanics and decrease neck pain and stiffness. Patient also performed vestibular stimulating exercises, functional static and dynamic balance exercises, trunk control exercises, and was given a home exercises program to perform on her own.

Results: Upon discharge from physical therapy, J.L. was able to perform activities and work without dizziness, “I am so much better”. Patient functional balance score goals were met and her cervical joint mechanics were normal without pain or stiffness. J.L. was able to increase her activity levels without increased dizziness or fear of falling.  

Benign Paroxysmal Positional Vertigo BPPV/Ear Rocks

History: T.H. is a 63 year old male who came to The Center for Balance complaining of room spinning vertigo while rolling over in bed onto his right side, reaching overhead, and bending to pick up objects off the floor. Patient describes his symptoms as, “room spinning when I lie down and when I wake up in the morning causing me to be sick to my stomach, someone told me my ear rocks or ear crystals are out”. Patient is presently employed as a lawyer and he and his wife enjoy walking, gardening, and social activities. Patient past medical history is unremarkable. Patient prior level of function; independent activities of daily living without vertigo or dizziness. Patient unable to perform independent activities of daily living safely because of episodes of vertigo causing severe dizziness and unable to maintain balance during episodes.

Examination:  Patient demonstrated a positive Dix-Hallpike test for Benign Paroxysmal Positional Vertigo (BPPV/ear crystal diplacement) in his right ear.

Assessment: Patient demonstrating BPPV right ear, room spinning vertigo.

Treatment: Therapist performed modified Eply maneuver (particle repositioning technique to put crystals back). Patient was given home precautions and education material on his condition and treatment course.

Treatment Outcome: Patient demonstrated negative Dix-Hallpike room spinning vertigo testing after one treatment session. Patient able to roll in bed, reach overhead, and bend without vertigo episodes. Patient has returned to prior level of symptom free activities of daily living.

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.