During this week neuro prac I had a new patient to assess. This man presented to NOP following a bilateral cerebellar infarct, three months ago. His referral letter stated to provide ongoing rehabilitation for this patient’s decreased balance.
My assessment included 6MWT, 10 meter WT, Bergs Balance, proprioreception, cerebellar testing. During his 6MWT he had a classical cerebellar signs. Ataxic gait with fixed trunk, wide BOS, decreased stride length. He did look very unstable.
When I started doing cerebellar testing to my surprise all the test, including finger nose test, heel shin, asthenia, rebound phenomenon, toe tapping were negative. The proprioreception was also adequate. I was very puzzled, as I thought this patient who had cerebellar stroke would ultimately have these tests positive? Then I thought, may be may testing skills weren’t precise, so I asked my supervisor to come and help me out as I couldn’t understand why the tests came out negative.
My supervisor did exactly the same tests as I did and they also came out negative.
Then my supervisor told me that this patient may had some vestibular implications.
That day my treatment with this patient consisted of increasing the patient’s postural tone by using the exercises on trampoline, walking around obstacles, fitball exercises. After 25 min of the treatment patient became ill and started vomiting. Well I thought that next treatment session should definitely include same vestibular testing, and get a better idea what was wrong with this patient to enable us to give him the most appropriate intervention.
I thought would be a good idea to share with you guys my experience with this patient, as didn’t know that patient presented with cerebellar stroke can have negative cerebellar tests. Cha, neuro is definitely isn’t as simple as I thought……
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