Presentation: A Caucasian, 80-year-old, right-handed, male, chiropractic physician, presented with brain fog, poor concentration, poor focus, gut problems, thyroid disease, and a fluctuating blood pressure. His main complaints are the brain fog and difficulty concentrating. He states that his symptoms have been of a gradual onset, and are getting worse the last 6 years. He states physical activities make them worse. He’s had no history of trauma, or drug abuse. A singular concussion was reported “about 50 years ago” by the patient.
Assessment: Upon examination the patient was alert oriented to self, time, place, and location. Maddox Rod testing exhibited a left esophoria. He had meiotic pupils bilaterally. Optic vein to artery ratios (V:A) were 3:1 on the right with leftward square wave jerks noted and 2:1 on the left. Unified Parkinson’s Disease Rating Scale (UPDRS) finger tapping and facial hypomimia, was essentially normal. With the assessment of rapid alternating hand movements, he was essentially normal. Gait analysis revealed a 30% decrease in stride length on the left leg. With gait while dual tasking his right arm swing decreased when asked to say every other month of the year. A physiological tremor was noted after perturbation testing, likely from thyroid hormone. Computerized posturography was performed, assessing stability on both a solid and foamed surface, with his eyes open, eyes closed, and multiple head positions. His overall average stability score on intake was 51.614%. His Graded Symptom Checklist composite severity was 69/162.
Intervention: A 5-day treatment plan was implemented involving nerve stimulation of the trigeminal nerve, gaze stability vestibular rehabilitation exercises, proprioceptive targeting on a foam surface, vision therapy, and single-axis rotation therapy being performed three times daily.
Outcome: After 11 treatment sessions in 5 days, overall posturography testing improved 40.74% (51.614% to 72.644%). His symptom severity scores dropped 82% (69/162 to 12/162). His physiological tremor was absent upon discharge exam. Equal stride length was noted on gait observation in both the natural and dual tasking. Optic V:A was 1.5:1 bilaterally.
Conclusion: 5-day, multi-sensory, intensive rehabilitation programs may be able to dramatically improve stability, cognitive performance, eye-tracking, and symptoms in the geriatric population.
Acknowledgements: The authors would like to thank Dr. Kelsey Brenner for her assistance in the treatment of this patient.