Physical Therapy Clinical Decision Making, Intervention, and Outcomes of a Patient with Cervicogenic Dizziness: A Retrospective Case Report

Background and Purpose: Cervicogenic dizziness (CGD) is believed to be a result of altered proprioception secondary to cervical spine pain and/or dysfunction...There currently are no validated clinical tests or clinical prediction rules to accurately identify CGD, however, there are published physical therapy clinical decision-making guidelines available. This retrospective case report describes the use of published guidelines to aid clinical decision-making regarding the physical therapy examination, interventions, and outcomes of a patient with CGD. Case Description: The patient was a 66-year old woman referred to PT with the medical diagnosis of dizziness. A detailed history and thorough examination revealed that the patient had signs and symptoms consistent with CGD. The clinical hypothesis was confirmed using a test-retest approach following a trial of manual therapy addressing the identified cervical spine dysfunction. Additional interventions included stretching, postural re-education, gaze stabilization, and proprioceptive training. Outcomes: Immediately following the initial treatment, the patient no longer reported dizziness during active seated neck rotation, which helped confirm clinical hypothesis of CGD. After six PT sessions, the patient reported complete resolution of dizziness during daily activities. The Dizziness Handicap Inventory score improved from 56/100 to 0/100, and the global rating of change (GROC) score was +6, representing “a great deal better. Discussion: In order to identify CGD, the physical therapist must skillfully screen for the presence of signs/symptoms of medical pathologies, vestibular disorders, and/or trauma. A test-retest method following a trial of manual therapy may be useful to confirm the clinical hypothesis. A multimodal approach combining musculoskeletal and somatosensory training was successfully implemented for this patient