Case Study 1: DIABETIC NEUROPATHY
76 year old Female Patient, formerly a Practicing Physician, Complained of Increasing Difficulty in Walking Independently.
She is a Known Diabetic since 40 Years.
Also a Known case of Glaucoma, Under Treatment.
had a recent Hysterectomy.
On examination:
  • Standing Posture: Kyphotic
  • Standing with Eyes Closed: Increased sway
  • Gait: Needed one Person or wall Assistance to walk, ascend and descend stairs, Climb out of a car.
  • Fine touch: Patchy around the Foot and ankle area. JPS: Intact.
Investigations:
  • EMG-NCV study: WNL
  • Balance Master Testing on a Static Force plate ( Neurocom system, version 8.6) showed severe Somatosensory Dysfunction and loss of ankle Strategy.
Treatment:
  • Was Initiated on an eyes-closed Balance Program on Unsteady Surfaces such as foam, for a Period of 2 months ( Progressively Increasing Difficulty).
  • This was followed by program on Equilibrium board for another two months.
Results: Currently she is able to walk Completely Independently across all Surfaces, Including, Unsteady, Smooth and Carpeted Ones.
Analysis: This Patient demonstrated Classic age related Degeneration of the somato-sensory system. The Surprising part was that Despite being diabetic for 40 years, she did not Demonstrate Diabetic Neuropathy ( EMG, NCV study: N) either sensory or motor. The ankle strategy was lost as a result of poor Somatosensory (proprioceptive) feedback. Hence the Imbalance in Gait. She was at a high risk for Falling.
Treatment on the foam Increased her Proprioceptive feedback and the Equilibrium board Restored the ankle Strategy.
 Case Study 2: VESTIBULAR HYPOFUNCTION
41 year old female with cervical pain and pain radiating to left upper arm since 8 months.
Prior to the pain, patient was doing rigorous Yoga, regularly, including head-stands and also jogging.
Pain started during one episode of a head-stand, where-in patient suddenly felt unable to maintain the head-stand, DURING the head stand and immediately after, she felt nauseous.
After the acute episode settled she was unable to walk comfortably in heels, which she had been doing easily for the past several years.
Investigations:
  • MRI: cervical spine: C5-C6 disc herniation with exiting nerve root impingement on the left side.
  • She was treated by 3-4 physiotherapists for cervical dysfunction, muscle strengthening and posture correction. However, radicular pain in the Left arm persisted. Infact, she began to experience pain the right deltoid region as well.
On clinical Examination.
Treatment:
  • Swiss Ball Program for realigning verticality.
  • Followed by balance program on foam, and Black Stability Trainer.
Results:
  • Complete resolution of radicular pain.
  • No Longer has a C7 "hump".
  • Has gone back to jogging, and partially resumed Yoga (has been advised not to continue with head stands).
Analysis:
Pt was doing head-stands, with a hypo-functioning vestibulo-spinal tract, which over the years, caused a forward head posture and dysfunctioning C5 mechanics. Restoration of the C5 mechanics alone would not treat the pain, unless vestibulo-spinal function was restored, so as to hold the cervical spine in correct position.