Developmental, Gait, and Balance Training in an Individual with a Vertebral Artery Dissection: A Case Report

Background: A vertebral artery dissection occurs when there is a flap-like tear in the vertebral artery. Blood quickly enters between the intima and media, and the blood coagulates, leading to an occlusion or stenosis. As a result, a vertebral artery dissection can cause an ischemic stroke in the cerebellum, brainstem, or spinal cord. The purpose of this case report is to present an inpatient rehabilitation plan of care for a patient suffering from a vertebral artery dissection and provide meaningful evidence-based information. Case Description: This case report focuses on a 31 year old female who injured her neck during a workout and subsequently visited the chiropractor. A few days later, she was admitted to the ER for headaches and vertigo. She was diagnosed with a vertebral artery dissection that resulted in a basilar artery thrombosis and stroke involving the bilateral cerebellum and the left paramedian pontine. Intervention: The focus revolved around the progression from neurodevelopmental and pre-gait tasks to gait, dynamic balance training, and functional tasks. Neurodevelopmental tasks focused on core stabilization and postural alignment in seated, quadruped, tall kneeling, and half-kneeling positions. Assessments: The primary outcomes throughout the plan of care were gait and balance based. The primary ones utilized were the amount of assistance, distance walked, Timed Up and Go Test, the Berg Balance Scale, and the Functional Independence Measure. Discussion: The mechanism of injury is something to take note of during the evaluation, as research has shown certain predisposing activities for a potential vertebral artery dissection. Interventions should revolve around breaking down the stages of gait into its simplistic feature, with a focus on facilitating normal postural alignment and movement patterns, and also regaining balance.