Case Presentation: 11 year-old male presents with a history of vasovagal syncope and symptoms of dizziness, nausea, headaches, depression, anxiety, photophobia, and hyperacusis
We are describing 11-year-old male who presents to a functional neurology clinic with a history of vasovagal syncope and symptoms of dizziness, nausea, headaches, depression, anxiety, photophobia, and hyperacusis.
During this examination, the patient demonstrated positive Romberg’s, inability to stand unassisted with pulsivity in all directions with a predominance of leftward retropulsivity. The patient demonstrated decreased left patellar reflex, hyperacusis on the right, saccadic intrusions in leftward and upward as well as saccadic eye movements away from any light stimulus. All aberrant eye movements were confirmed by videonystagmography. The patient participated in a two-week vestibular rehabilitation program that included multi-axis labyrinth and otolithic stimulation paired with specific eye movements and exercises.
Dr. Mark Wade presents his thoughts on this case presentation.
I’m gonna start off where Stephen was leaving off. I’m gonna take this as a typical case that would come into my clinic with some balance issues, as compared to potentially somebody with more serious neurological issues that may present and do, for example, the functional neurologist. So this is actually something that’s kind of a common issue. We often see patients with balance and coordination issues, not necessarily to the degree of a neurological disorder and full blown, but it is most common cause for the hospital visits in the elderly is falls. And this issue can begin at any age, especially in today’s society. I’m gonna bring it with my PhD in Public Health back to a public health kind of point of view, that in today’s society with the lack of balance and coordination exercises being performed, this is becoming a common, if not an epidemic type of issue.
We have video games that may have improved hand to eye coordination, but most kids now can’t stand on one leg for more than a few seconds without falling over. When everyone should be able to balance with stability for at least 30 seconds with correct posture. Now, I’d like to begin like I always do with a posture scan for any major postural distortion patterns. Based on the epidemic of tech neck and iPhones and video games, et cetera, I would suspect in this case with an 11-year-old child to find some forward head posture occurring. Now, this is the most postural distortion pattern in this posture quadrant. And the research does show that more than 50% of kids today are presenting with this. And this is partly due to heavy backpacks and a lack of ergonomic and postural hygiene awareness in the schools. Now, the reason this would concern me with forward head posture is it’s been shown to directly decrease balance and coordination.
The good news is kids respond quickly to a postural correction program. So how I would proceed to correct or improve this particular problem is first structurally. I would perform some CPC protocol or manual correction targeted primarily at the thoracic spine as a majority of all forward head posture is actually cause to an increase in kyphosis of the thoracic spine, so manual therapy there. And then I would supplement that treatment with a little bit of vibration therapy. This has also been shown to greatly help increase some of the proprioception.
Now, I would have the kid doing some postural alignment exercises to reinforce the postural corrections such as like wall posture or dynamic functional movements as Stephen mentioned but focusing on preventing postural collapse as well as some distraction of that thoracic spine. Additionally, I would want the boy on one leg as much as possible training his balance. This is like any other factor, the more we work on our balance, the better it becomes. Again, this is ruling out for example a serious neurological issue. I was addressing this as a person that could stand to some degree on their own without falling over. If it was a person that could not stand unassisted, obviously we wouldn’t be performing any of this. I would be referring that out to somebody like Dr. Brandon.
So one-leg balance exercise with correct posture then increasing to an in-stable service and on to more advanced balanced exercise. So I would expect to see with that on a normal 11-year-old child with some forward head posture, postural distortion issues that is causing these balance disorders. I’d expect to see some great changes in his posture and in his balance and coordination with as little as 12 weeks. So that’s how I would go about that.
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Dr. Mark Wade D.C, PhD, CPE,
Dr. Mark Wade is the founder of the American Posture Institute, creator of the Certified Posture Expert program, board member of the International Posture Association and President of the Council On Human Function. Dr. Mark is considered one of the most “Certified” Posture Experts on the Planet, having obtained more than 45 certifications in posture, neurology, and human function, including a PhD in Public Health. Clinically Dr. Wade has worked with professional athletes and sports teams in every major sports arena and has served as the official Posture Practitioner for the 4 Time National Champions – Parma Panthers. He has become widely known for his ability to help individual athletes and teams perform at their maximum potential having achieved a total of 7 national championships.