Physical Therapy Clinical Decision Making, Intervention, and Outcomes of a Patient with Cervicogenic Dizziness: A Retrospective Case Report
Melissa Koehl, PT, DPT, OCS, COMT; Roberta O’Shea, PT, DPT, PhD; Amy Nagel, PT, DPT; Dale Schuit, PT, PhD, MS
Department of Physical Therapy, Governor’s State University, IL
Study Design: Single-subject case design.
Background: Cervicogenic dizziness (CGD) is believed to be a result of altered proprioception secondary to cervical spine pain and/or dysfunction. There currently are no validated clinical tests or clinical prediction rules to accurately identify CGD, however, there are published physical therapy clinical decision-making guidelines available.
Case Description: The patient was a 66-year old woman referred to PT with the medical diagnosis of dizziness. A detailed history and thorough examination revealed that the patient had signs and symptoms consistent with CGD.
The clinical hypothesis was confirmed using a test-retest approach following a trial of manual therapy addressing the identified cervical spine dysfunction. Additional interventions included stretching, postural re-education, gaze stabilization, and proprioceptive training.
Outcomes: Immediately following the initial treatment, the patient no longer reported dizziness during active seated neck rotation, which helped confirm clinical hypothesis of CGD. After six PT sessions, the patient reported complete resolution of dizziness during daily activities. The Dizziness Handicap Inventory score improved from 56/100 to 0/100, and the global rating of change (GROC) score was +6, representing “a great deal better.
Conclusion: A test-retest method following a trial of manual therapy may be useful to confirm the clinical hypothesis. A multimodal approach combining musculoskeletal and somatosensory training was successfully implemented for this patient.
Effects of Circuit Training on Return of Physical Function in a Patient Recovering from Guillain-Barré Syndrome: A Case Report.
Thomas L. Christ, SPT, MS; Niamh M. Tunney, PT, DPT, MS
Department of Physical Therapy, Mercer University Atlanta, GA
Study Design: Case study.
Objectives: The purpose of this case report was to describe the effects of circuit training on gait function, strength, endurance, and balance with an individual later in the recovery phase from GBS.
Background: Individuals recovering from Guillain-Barré Syndrome (GBS) experience a broad range of functional impairment with recovery often taking six months to two years. Limited evidence exists on exercise parameters for restoration of functional impairments.
Case Description: A 68-year-old women diagnosed with GBS presented to outpatient physical therapy six weeks after hospital discharge and one week after home health therapy discharge. Outpatient physical therapy was provided two times a week for nine weeks. Interventions were designed around a circuit with the patient performing each of 4-6 exercises once before repeating them for a second set.
Results: Improvements in FGA (10/30 to 21/30), gait velocity (0.65m/s to 1.04m/s), five times sit to stand (17.59s to 15.4s), 6MWT (290 meters to 336 meters) and ABCs (50% to 70%) following nine weeks of skilled physical therapy were noted.
Conclusion: Results suggest circuit training interventions may be beneficial for restoring gait function, strength, endurance, and balance in the outpatient rehabilitation setting for a patient recovering from GBS. Further research is warranted.