Differential Diagnosis of the Vestibular System and Effectiveness of a Vestibular Rehabilitation Program Following Radiation Treatment for Tonsil Cancer: A Retrospective Case Report

Background/purpose: Impairments in the vestibular system are a common diagnosis seen in physical therapy today. The most common vestibular diagnosis is Benign Positional Vertigo (BPPV) with vestibular hypofunction occurring second most common. Vestibular hypofunction usually results from neuritis, chronic inflammation of peripheral system, or infection. Previous studies examined the effectiveness of vestibular rehabilitation training on postural stability and gaze stabilization for individuals with bilateral or unilateral vestibular hypofunction but research is limited for vestibular rehabilitation training following radiation treatment. Therefore, the purpose of this retrospective case report is to document the impact of a vestibular rehabilitation program on improving vestibular hypofunction, resulting from neurotoxicity following radiation treatment. Case Description: The subject was an 88 year old Caucasian female who had reported symptoms including: dizziness, lightheadedness, and “feeling off” when moving her head and changing positions, specifically from supine to sitting. The patient reported symptoms began approximately 3 weeks ago following the end of her last radiation treatment for palatine tonsil cancer in her neck. Outcomes: The patient was seen by an SPT, supervised by a PT for a total of six visits. Improvements in both the DGI and DHI were found when compared to baseline following 6 visits of physical therapy. Discussion: The purpose of this case report was to analyze the effects of a vestibular rehabilitation program with inclusion of balance training, vestibular rehabilitation, and lower extremity strength training on improvement in dizziness and instability with walking. Results from tests and measures suggested vestibular hypofunction was the diagnosis present in this patient, not BPPV. Considerable improvement in Romberg test was observed along with improved results from the Head Impulse test, DHI & DGI outcome measure scores, and subjective decreased reports of dizziness. With the dizziness reportedly beginning a few weeks following radiation treatment in the cervical region for tonsil cancer, radiation damage to the vestibular system must be considered as a possible contributor to the onset of her symptoms. Physical therapy is not well understood for post-radiation damage to the vestibular system and warrants further research

Integration of Cervical and Scapular Mobilization and Stabilization for a Patient with Medial Epicondylitis: A Case Report

Background and Purpose: Lee et al. discovered a correlation between cervical radiculopathy and medial epicondylitis. 1 There have been no follow up studies indicating whether one pathology leads to the others or whether treating cervical radiculopathy affects the concomitant medial epicondylitis. The purpose of this case report is to outline a treatment program for individuals with cervical radiculopathy and concomitant medial epicondylitis . Case Description: The patient was a 54 - year - old, Hispanic female who presented with complaints of right - sided, m edial elbow pain as well as grip, wrist, and elbow weakness. Upon further evaluation, the patient also presented with cervical radiculopathy. The patient did not receive any steroid injections for medial epicondylitis. Patient had significant past medical history including right shoulder adhesive capsulitis and bilateral lateral epicondylitis. Outcome Measures: The patient was assessed using the QuickDASH, pain rating via Numeric Pain Rating Scale (NPRS), strength via Manual Muscle Testing (MMT), grip stren gth via dynamometer, as well as a cervical radiculopathy cluster exam. The patient was seen for a total of 7 visits over the course of 4 weeks. Discussion: Treating concomitant cervical radiculopathy in a patient with medial epicondylitis appeared to be a safe and effective intervention program for decreasing elbow pain and improving grip strength. The presenting case report may be useful in helping clinicians determine optimal plan of care for patients with “golfers elbow”. Future randomized control trials should evaluate the relationship between cervical radiculopathy and medial epicondylitis as well as whether treating cervical radiculopathy improves patient outcomes in those with “golfers elbow”

Treatment Of A Patient With Essential Tremor Seen In Outpatient Physical Therapy: A Retrospective Case Report

Background and Purpose: Essential tremor is one of the most common progressive neurological conditions affecting many adults and older individuals, however there is limited research of the effects of therapeutic interventions in relation to physical therapy. The purpose of this retrospective case report is to highlight interventions used in the treatment of a patient with essential tremor in an outpatient physical therapy clinic and the outcomes of those interventions. Case Description: The patient was a 68 year-old female with essential tremor. She also presented with severe COPD, impaired distal extremity sensation, and history of mini strokes, asthma, pneumonia, and kidney issues. The interventions utilized in this study included resistance training, neuromuscular training, soft tissue and joint mobilization, the modality anodyne and functional training. Outcomes: The patient was seen for a total of eleven visits over a seven-week period with four cancelations due to illness. Improvements in Berg Balance Scale (BBS) of 5 points, Functional Gait Assessment (FGA) of 8 points and Lower Extremity Functional Scale of 18 points. She also demonstrated improvements in sensation, strength and a decrease in pain and reported cervical stiffness. Discussion: This case report demonstrates the role physical therapy can have on the treatment of a patient with essential tremor and the need for continued research of specific interventions as it relates to physical therapy. Due to the complexity and evolving nature of the patient, clinical reasoning was highly utilized in creating and modifying this patient’s plan of care

Assessment and treatment strategies in a young female athlete with lateral knee pain, a retrospective case report.

Abstract: The purpose of this retrospective case report is to describe the usefulness of a comprehensive assessment of the musculoskeletal and neurological systems and treatment of components of the kinetic chain in a teenage athlete with chronic lateral knee pain. Method: This is a retrospective case report. Discussion: Significant qualities of this case include identification of possible tibiofibular dislocation, optimization of lower extremity (LE) alignment, use of foot orthoses during phases of recovery and utilization of the Knee injury and Osteoarthritis Outcome Score (KOOS) during this cycle of care. Conclusion: When treating a patient with lateral knee pain, full consideration of alignment, fibular position and stability, proprioception, balance, strength and motor control of hip, knee, ankle and foot as well as the contralateral LE and trunk should be considered as influential factors that may need to be addressed