Rehabilitation for a complex patient following cerebellar hemorrhage and obstructive hydrocephalus: A case report.

BACKGROUND AND PURPOSE: Inpatient rehabilitation facilities play an integral role in patient progress post-stroke. Cerebellar hemorrhages are an infrequent type of stroke and are therefore less discussed in the literature; however, inpatient rehabilitation continues to be an integral part of patient recovery. The purpose of this case report is to discuss the physical therapy interventions, challenges, and successes for a complex patient with a large cerebellar hemorrhage with obstructive hydrocephalus. Case Description: The patient is a 32-year-old male admitted to an inpatient rehabilitation facility. Prior to admission, the patient spent 1 month at a local hospital following a complicated recovery status post cerebellar hemorrhage with obstructive hydrocephalus. Interventions: The patient participated in at least 3 hours of combined therapy a day, split into 30- and 60-min sessions, and divided between physical, occupational, and speech therapy. Physical therapy interventions focused on various gait and coordination activities. Outcomes: The patient spent 47 days in an inpatient rehabilitation facility and demonstrated improvements in all aspects of the Functional Independence Measure®. The patient improved from an 18 to a 90 on the total FIM® score, allowing the patient to ultimately be discharged home with family able to provide 24/7 supervision.

Vibrotactile Feedback Alters Dynamics Of Static Postural Control In Persons With Parkinson's Disease But Not Older Adults At High Fall Risk.

BACKGROUND: Aging and Parkinson's disease are often associated with impaired postural control. Providing extrinsic feedback via vibrotactile sensation could supplement intrinsic feedback to maintain postural control. RESEARCH QUESTION: We investigated the postural control response to vibrotactile feedback provided at the trunk during challenging stance conditions in older adults at high fall risk and individuals with Parkinson's disease compared to healthy older adults. METHODS: Nine older adults at high fall risk, 9 persons with Parkinson's disease and 10 healthy older adults performed 30s quiet standing on a force platform under five challenging stance conditions with eyes open/closed and standing on firm/foam surface with feet together, each with and without vibrotactile feedback. During vibrotactile feedback trials, feedback was provided when participants swayed >10% over the center of their base of support. Participants were instructed vibrations would be in response to their movement. Magnitude of postural sway was estimated using center of pressure path length, velocity, and sway area. Dynamics of individuals' postural control was evaluated using detrended fluctuation analysis. RESULTS: Results showed that vibrotactile feedback induced a change in postural control dynamics among persons with Parkinson's disease when standing with intact intrinsic visual input and altered intrinsic somatosensory input, but there was no change in sway magnitude. However, use of vibrotactile feedback did not significantly alter dynamics of postural control in older adults with high risk of falling or reduce the magnitude of sway. SIGNIFICANCE: Considering the effects of vibrotactile feedback were dependent on the population and stance condition, designing an optimal therapeutic regimen for balance training should be carefully considered and be specific to a target population. Furthermore, our results suggest that explicit instructions on how to respond to the vibrotactile feedback could affect training outcome.