A 73-year-old female was admitted to the hospital 2 days ago for an elective right total hip replacement due to severe osteoarthritis and pain in her right hip. The surgery involved a posterior surgical approach with replacement of both the acetabulum and the femoral head. Notable past medical history includes osteoporosis, complaints of positional dizziness, hypercholesterolemia, and type 2 diabetes mellitus. The surgical team stated that she must follow hip precautions (no hip flexion past 90°, no internal rotation/crossing of legs) and she could bear weight as tolerated. The physical therapist is asked to evaluate and treat the patient before she is discharged to her two-story home in 2 to 3 days with her husband, who is retired but limited in his physical ability to assist her due to a recent history of back surgery. She will have a few home physical therapy and nursing visits following discharge and then she plans to attend outpatient physical therapy to continue postsurgical treatment of her hip. Her current complaints are pain in her right hip and short duration complaints of dizziness associated with positional changes.
Based on her health condition, what do you anticipate will contribute to her symptoms of dizziness?
What are the examination priorities?
What are the most appropriate examination tests?
What are the most appropriate physical therapy interventions?
What precautions should be taken during physical therapy interventions?
What are possible complications interfering with physical therapy?
How would this individual's contextual factors influence or change your patient/client management?
- DIZZINESS: Symptoms that can have several meanings to different individuals; may include sensations of lightheadedness, disorientation, imbalance, or vertigo; may be related to increased heart rate (HR), a vasovagal event, syncope, nystagmus, and/or feelings of anxiety
- NYSTAGMUS: Repeated rapid alternating eye movements that include slow (one direction) and fast phases (opposite direction); direction of nystagmus is named for the fast phase movements
- TRIAD OF HEAD ORIENTATIONS SIGNS: Three cardinal signs associated with acute unilateral vestibular hypofunction. Signs include: (1) ocular skew deviation (or tilt) where one eye is deviated up and one eye is deviated down, (2) ocular torsion where eyes roll away from head orientation, and (3) head tilt toward the side of unilateral vestibular imbalance.
- UNIDIRECTIONAL NYSTAGMUS FOLLOWING ALEXANDER'S LAW: Spontaneous and gaze-holding nystagmus usually seen in acute stage of unilateral vestibular hypofunction; nystagmus is horizontal, with the fast phase beating away from the ear with decreased sensory function. Alexander's law indicates that the nystagmus will decrease in intensity when the eyes gaze toward the involved side and increase in intensity when they gaze away.
- VERTIGO: Sensation of rotation or spinning; person either feels like she is spinning or as if her surroundings are rotating around her
- VESTIBULAR OCULAR ...
Log In to View MoreYour institution's subscription does not include access to this resource. If you have an individual subscription to this resource, please sign in below. Otherwise, contact your librarian to request access for your institution or view individual subscription options below.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
Create a Free MyAccess Profile
Note: If you have registered for a MyAccess profile on any of the Access sites, you can use the same MyAccess login credentials across all sites.
Benefits of a MyAccess Profile:
- Remote access to the site off-campus on any device
- Notification of new content via custom alerts
- Bookmark your favorite content such as chapters, figures, tables, videos, cases and more
- Save and download images to PowerPoint
- Self-Assessment quizzes saved for quick review
- Custom Curriculum access for both instructors and learners
AccessPhysiotherapy Full Site: One-Year Subscription
Connect to the full suite of AccessPhysiotherapy content and resources including interactive NPTE review, more than 500 videos, Anatomy & Physiology Revealed, 20+ leading textbooks, and more.
Pay Per View: Timed Access to all of AccessPhysiotherapy
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.