"Help!" This was the last thing L.C. remembers before waking up in the intensive care unit of a hospital. Apparently, L.C. was suffering from a severe headache while sitting at her desk at work. She cried out for help and co-workers found her lying on the floor near her desk.

L.C. was taken to the hospital where she had a CT scan. This scan revealed a subarchnoid bleed. While in the hospital, L.C. fell. Her husband reported that he condition worsened. She was no longer able to ambulate, had difficulty standing and reported an increase in pain and dizziness. A few weeks after suffering the subarchnoid bleed, L.C. was transferred to the acute rehabilitation unit of the hospital. At this time, L.C. was reporting severe headaches, increased dizziness, and pain. In order to alleviate these symptoms and to control increased pressure within the skull, a ventriculoperitoneal shunt was placed to drain excess cerebrospinal fluid (CSF) from the ventricles of the brain into the abdomen (peritoneal).

Like many other individuals who suffer a brain injury, L.C. experienced changes in her cognitive, physical and psychosocial functioning. Cognitively, L.C. had difficulty focusing her attention, organizing and sequencing a series of steps, decreased short-term memory, and decreased verbal fluency. Physically, L.C. suffered from increased dizziness, decreased balance, impaired vision, difficulty walking, decreased endurance, severe headaches, and nausea. Emotionally, L.C. suffered depression about her current situation and increased irritability.

Approximately, two months after falling at work and sustaining a subarchnoid hemorrhage, L.C. was admitted to the modified inpatient program at Centre for Neuro SkillsŪ in Los Angeles, CA. Centre for Neuro SkillsŪ is a postacute brain injury rehabilitation program. Upon admission, L.C. required 24-hour supervision secondary to mobility issues, balance and visual deficits, decreased memory and processing speed, all of which compromised her safety. L.C. participated in occupational and physical therapies, as well as counseling and cognitive rehabilitation at the clinic and then received additional assistance in her home from her husband and neurorehabilitation specialists.

One month after being admitted to Centre for Neuro SkillsŪ, L.C. no longer required 24-hour supervision and was able to ambulate with a single point cane. After a series of diagnostic tests performed by physical therapists at Centre for Neuro SkillsŪ, L.C. was diagnosed with probable Benign Paroxsymal Positional Vertigo (BPPV). Dizziness, visual complaints, nausea, headaches, irritability, sensitivity to bright lights, decreased attention and concentration, as well as involuntary eye movements are all symptoms of BPPV and were experienced by L.C. BPPV is a condition that is caused when particles of calcium carbonate (otoconia) migrate into the inner ear. These particles can become displaced after trauma to head and thus, BPPV is commonly seen after brain injury. The vestibular system, which is involved in the maintenance of head and body equilibrium, is affected by this condition. L.C. was given the Dix-Hallpike test, which involves having the patient move from a sitting to a supine position, with their head turned 45 degrees to one side and extended approximately 20 degrees backwards. A positive Dix-Hallpike test will cause a burst of nystagmus (jumping of the eyes).

L.C. received the Epley maneuver as treatment for BPPV. This procedure involves sequential positioning and movement of the head. After L.C. underwent the Epley maneuver, her dizziness, involuntary eye movements, nausea and headaches were significantly reduced. After 60 days of rehabilitation at Centre for Neuro SkillsŪ, L.C. was discharged from the program. She had made substantial gains in all domains of functioning. Memory improved, verbal fluency increased, organizational skills improved, irritability and depression subsided, dizziness decreased, headaches dramatically decreased both in frequency and severity, nausea resolved, visual processing skills increased, and she was able to ambulate independently. L.C. was undergoing a driving evaluation at the time of discharge to determine if her visual deficits had resolved enough to regain driving.

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