We report a case of chronic dizziness and frailty that improved with a combination of exercise and medical guidance.
The patient was an elderly 77-year-old woman with a floating sensation and decreased activity due to chronic dizziness. Approximately one year after the onset of her symptoms, she was started on outpatient rehabilitation. At the beginning of the program, the VEMP (Vestibular Evoked Myogenic Potential) was unremarkable, the DHI (Dizziness Handicap Inventory) score was 54, the HADS (Hospital Anxiety and Depression Scale) score for anxiety/depression was 9/14, and the Kihon Check List (KCL) score was 11. These results suggested psychogenic dizziness and frailty.
First, exercise therapy, including with a balance exercise assist robot (BEAR), was performed once a week for two months. BEAR is a training robot that manipulates back and forth shift and horizontal rotation by moving the center of gravity while playing a game. Previous studies have shown that BEAR exercises improve muscle strength and balance ability in frail older adults (Ozaki, 2017).
Physical function (gait speed, muscle strength) improved after the intervention, but the dizziness and anxiety symptoms persisted. Then, medical guidance based on the Cognitive Behavioral Therapy Manual (Seki, 2016) was provided once a week for 2 months to listen to the person's thoughts and discuss how to respond. Finally, her DHI score improved to 38 points, the HADS score to 1/2, and the KCL score to 5, the dizziness and anxiety were reduced, and frailty improved.
Improved physical functioning and reduced anxiety through exercise and medical guidance may have contributed to the improvement of the chronic dizziness and frailty in this patient. .
We propose to continue to investigate more effective interventions and validate the indications.
