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A Case Study of a Physical Therapy

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The patient is a 50 year old female referred by her primary care physician with dizziness that began 2 weeks after an upper respiratory infection. She was treated for a right ear infection. She has a left beating nystagmus with the horizontal headshake test, and a saccadic correction after a right head thrust.

Write down activity limitations of this patient, and treatment suggestions including how you would progress their treatment during the course of physical therapy treatment?

Answer:

Scientists and researchers have found out that dizzy patient has a tendency to have other body related pathologies that include ear, throat, nose, etc. Similarly, in the case of the 50-year-old female patient she was suffering from an upper respiratory infection and was also treated for a right ear infection. Later, physical examinations have found out that the patients have a left beating nystagmus and a saccadic correction after a right head thrust (Bhattacharyya et al., 2008).


However, due to all these reasons the patient needs to abide by some of the activity regulations. These rules and regulations include getting up slowly from the bed and sitting on the edge of the bed before standing, try to avoid leaning to pick up anything from the ground and avoid sleeping sideways with the year as that may cause fatal and severe consequences. Other regulations that the patient should follow is to remain extra careful while reclining, avoiding physical sports like football, rugby that requires a substantial body movement and jerking. Moreover, the patient needs to avoid to move the head up and down and avoid tilting the head frequently. These are some of the limitations and restrictions regarding the activities that the patient needs to follow the physical therapy (Fife et al., 2008).

The treatment of the patient may follow various steps which include self-treatment of the patient by following the method of Brandt-Daroff exercises. This process will help the patient's brain to get accustomed with the abnormal signaling that is triggered from the inner ear. Moreover, this exercise would help the patient to regain her balance too. This method is needed to get followed by Canalith Repositioning Procedure (CRP) associated with various maneuver therapy to promote a healthy vestibule for the concerned patient.  This CRP procedure is very much helpful in moving the otoconia in a place inside the ear where it will not create any problems and dizziness for the patient. This simple method is associated with various maneuver techniques. However, in the case of this particular patient Epley maneuver therapy should be followed as it provides a better physical therapy (Kutz 2010). 

At first, the patient is requested to sit in an upright posture with her leg fully extended. The head of the patient needs to get rotated at a 45-degree angle which would give a positive Dix-Hallpike test. In the next instance, the patient is advised to lay down backward with her head lying at a position of 30 degrees. After, 2 minutes the patient head is required to get moved (rotated) at an angle of 90 degrees, however, the patient need to face her head in a downward position. The patient is allowed to sit in such posture for more than 2 minutes. Finally, the patient is brought up and  is permitted to sit in an upright position for about 30 – 40 seconds. This Epley or repositioning maneuver technique helps the free-floating particles to get relocated within the semicircular canal helping the patient to get rid of the dizziness (Post & Dickerson 2010).

However, some other maneuver techniques can be followed along with the Canalith Repositioning Procedure (CRP) which includes Semont maneuver and Gufoni maneuver techniques and others.  Nevertheless, all these techniques and methods are focused on removing the debris out of the ear and provide the patient to get rid of Benign Paroxysmal Positional Vertigo (BPPV). Furthermore, some small activities are believed to help the patient to get cured and overcome the benign paroxysmal positional vertigo (BPPV) related problems. These activities and exercises often considered as an important part of the therapy and treatment. These small activities and tasks include proper balance exercises like standing up with the feet resting together, moving the head from side to side, rotating the head slowly, etc. Moreover, the following exercises need to be performed by the patient on a regular basis (at least five times a day for the two weeks and so on) (Troxel, Drobatz & Vite 2015).

Lastly, the patient need to undergo a Vestibular rehabilitation therapy (VRT). This is an exercise based program focused on curing both the primary and secondary problems faced by the patient. This treatment is totally emphasized on exercises such that it can reduce the dizziness, vertigo, instability, falls and imbalance among the patients. This therapy is a problem-oriented approach, and it highlights and figure out the problem of each patient distinctly. Moreover, the process of VRT is highly focused on delivering three methods of exercise techniques which include Habituation, Gaze stabilization, and Balance Training (Zaidi & Sinha 2013). Moreover, these are the overall processes that are needed to get followed (as a physical therapy treatment) for the 50-year-old patient.

Reference

Bhattacharyya, N., Baugh, R. F., Orvidas, L., Barrs, D., Bronston, L. J., Cass, S., ... & Fuller, D. C. (2008). Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngology-Head and Neck Surgery,139(5), S47-S81.

Fife, T. D., Iverson, D. J., Lempert, T., Furman, J. M., Baloh, R. W., Tusa, R. J., ... & Gronseth, G. S. (2008). Practice Parameter: Therapies for benign paroxysmal positional vertigo (an evidence-based review) Report of the Quality Standards Subcommittee of the American Academy of Neurology.Neurology, 70(22), 2067-2074.

Kutz, J.W., (2010). The dizzy patient. Medical Clinics of North America, 94(5), pp.989-1002.

Post, R. E., & Dickerson, L. M. (2010). Dizziness: a diagnostic approach.Am Fam Physician, 82(4), 361-68.

Troxel, M. T., Drobatz, K. J., & Vite, C. H. (2015). Signs of neurologic dysfunction in dogs with central versus peripheral vestibular disease. Journal of the American Veterinary Medical Association, 227(4), 570-574.

Zaidi, S. H., & Sinha, A. (2013). Benign Paroxysmal Positional Vertigo (BPPV). In Vertigo (pp. 81-90). Springer Berlin Heidelberg.


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