Improvements in balance and the apprehension of falling in a post-stroke patient
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1
Innova Brain Rehabilitation Center, United States
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2
Life University, United States
Background:
A 49-year-old female patient presented to a chiropractic neurology clinic with primary complaint of balance problems and a strong apprehension of falling. She had an ischemic stroke in 2009 caused by carotid dissection. The stroke resulted in a partial left sided paralysis. The patient reported feeling her left foot twisting during gait, necessitating the use of a cane for ambulation. Additional complaints were increased emotionality, insomnia, moderate fatigue and low energy.
Methods:
Upon examination, she revealed decreased sensation to sharp touch, light touch, vibration and position sense in the upper and lower left extremities. She reported diminished sensation on the entire left side of her face. Weber’s testing revealed sound lateralized to the right side. Tongue protrusion was midline but strength was weaker on the left. Point localization showed consistent inaccuracy by 3 inches on the left arm. Her left foot was cold to the touch. She was able to perform a squatting position but displayed a dysfunctional gait. The patient received treatment for a total of 6 days at a frequency of 3 times a day.
Treatments consisted of mirror therapy involving marching and stepping up and down was utilized to provide visual feedback to improve her motor patterns. Gait training exercises were used with and without a mirror. Eye movement therapy was performed with saccades up and left and pursuits down and left. Repetitive peripheral sensory stimulation (RPSS) was performed on the left peroneal nerve, left posterior tibial nerve, along the dermatomes for L3 and L4. Between treatments, patient followed a home exercise protocol which consisted of computerized eye movement exercises. These eye exercises focused on right sided cortical activation in an effort to improve left sided movement.
Results:
After 6 days of treatment, the patient reported an improvement in perceived balance problems, which decreased from severe to mild. Her gait had significantly improved, such that she was no longer reliant on the cane for ambulation, although she continues to use it as she reports, “just in case”. She no longer had anxiety nor a fear of falling. The patient had an increase in her perception of sharp and light touch as well as vibration in her upper and lower left extremities. She reported a concomitant increase in energy and diminished fatigue.
Conclusion:
In this patient case, employing chiropractic neurology strategies proved very effective in treating a post stroke patient’s severe balance and sensory symptoms. These results promote further research of functional neurorehabilitation in the treatment of post stroke patients.
Keywords:
post-stroke,
Imbalance,
chiropractic neurology,
Neurorehabilitation,
Hemi-paresis
Conference:
International Symposium on Clinical Neuroscience 2018, Orlando, Florida, United States, 24 May - 26 May, 2018.
Presentation Type:
Poster
Topic:
Clinical Applications in health, disease, and injury to the nervous system
Citation:
Patterson
FE,
Chydenius
R and
Esposito
SE
(2018). Improvements in balance and the apprehension of falling in a post-stroke patient.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience 2018.
doi: 10.3389/conf.fneur.2018.60.00121
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Received:
06 Apr 2018;
Published Online:
14 Dec 2018.
*
Correspondence:
Dr. Susan E Esposito, Life University, Marietta, United States, susanesposito@gmail.com