1. Could you describe a patient case that presented significant challenges?
One of my most memorable patients was an older adult who was experiencing severe vertigo, recurrent falls, and significant balance impairments while also serving as the primary caregiver for her husband, who was experiencing cognitive decline. Her vertigo episodes were so severe that they occasionally caused intense nausea, profuse sweating, and left her unable to function for an entire day. She had difficulty walking in a straight line, demonstrated a significant posterior shift in her center of gravity, and was unable to maintain unsupported standing with her eyes closed.
Despite her own physical limitations, she relied on her husband for support when walking outside the home-even though he also had a history of falls. The situation created a cycle where both individuals were at risk for injury while trying to care for one another. Building trust became just as important as treating her physical impairments, as she was understandably fearful that therapy could trigger her vertigo symptoms.
2. What therapies or treatment approaches did your team recommend and implement to address the patient’s condition?
Her treatment plan was highly individualized and focused on restoring balance, reducing vertigo, improving gait mechanics, and increasing her confidence with mobility.
Interventions included manual therapy to address cervical and muscular restrictions, gait training, balance and neuromuscular re-education to improve her center of gravity and kinesthetic awareness, stretching to improve lower extremity mobility, and shoe modifications with metatarsal bars to improve toe-off during walking.
Because of her anxiety surrounding vertigo, we initially focused on gentle techniques, including craniosacral therapy and education on acupressure strategies to help manage nausea should symptoms occur. As trust developed, she agreed to undergo canalith repositioning using the Epley maneuver. Although the initial treatments temporarily reproduced her symptoms, subsequent sessions resulted in dramatic improvement. She was also educated on the Semont maneuver and provided with resources to safely manage any future episodes independently at home.
Beyond her physical rehabilitation, we recognized the emotional impact of being a caregiver. We encouraged additional psychosocial support, recommended community resources such as the local senior center’s weekly mah jong group, and helped her identify meaningful leisure activities she could safely return to, including spending time outdoors, dining out with her husband, and attending movies.
3. What outcomes were achieved following the implementation of the treatment plan?
By discharge, the transformation was remarkable. Her vertigo had completely resolved, her balance had improved significantly, and she demonstrated functional abilities that had once seemed impossible. During her final therapy session, she independently completed advanced balance activities, including standing on an unstable surface while performing weighted reaching tasks with confidence.
Most importantly, she regained her independence. She proudly shared that she no longer needed to hold onto her husband while walking, allowing both of them to move about more safely. She also reported that her husband had become more independent at home, including taking out the trash on his own.
The greatest success, however, extended beyond objective clinical measures. She returned to enjoying the simple pleasures that had once defined her life—spending time outside in the sunshine, playing mah jong, going to the movies, and dining at one of her favorite restaurants. Watching her rediscover confidence, independence, and joy while reducing her risk of falls was an incredibly rewarding outcome for both the patient and our therapy team.
