The patient is a 71-year-old right-handed man with a large, right-sided cerebellar brain tumor status post-resection and ongoing chemotherapy.
History of Present Illness:
Two years ago the patient developed an insidious onset of headache, nausea, vomiting, and progressive gait instability. A visit to the emergency department and subsequent magnetic resonance imaging revealed a large right cerebellar mass measuring 4 cm (1.6 in.). He underwent tumor resection 5 days later. The pathology report revealed Stage 4 glioblastoma multiforme. At that time, he required a wheelchair as his primary mode of locomotion. He was then sent to inpatient rehabilitation for 3 weeks and chemotherapy and radiation was initiated, which was completed 6 months ago. The patient is now taking an experimental study drug to prevent tumor regrowth and was referred to outpatient physical therapy to address incoordination and impaired balance and gait. He failed a driving test 1 month ago owing to coordination impairments. In the last 6 months, he has not required an assistive device and has not experienced any falls.
Patient has a history of hypertension. Current medications include methylphenidate, atenolol, and levetiracetam.
The patient is married, lives with spouse, and is a retired mechanical engineer. Wife is very supportive. Patient is active in church activities and enjoyed bicycling.
Patient lives in a multiple-level home with three flights of stairs. He has the following durable medical equipment: wheelchair, front-wheeled walker, cane, and gait belt.
General Health Status:
Good. His prior level of functioning was fully independent and active. Before brain tumor diagnosis, the patient rode his bicycle from California to Florida.
The authors extend their thanks to Elizabeth Trawinski, Idaho State University, for her assistance in preparing this case study.
Postural examination The patient demonstrates normal postural alignment during static standing.
Tests and Measures (initial examination)