Clinical examination shown:
1. Wide base gait
2. Can’t perform single leg stand
3. Can’t perform modified rhomberg.
4. Positive signs of dysmetria with finger to nose and heel shin sliding tests.
5. Manual listening to posterior cranium and cranial mechanic flexion dysfunction
6. no other upper motor neurons signs

Clinical reasoning:
Patient presented with signs of cerebellar lesions from the clinical examination.
Treatment will be to:
1. Refer to neurologist for further examination
2. Neurology rehab to improve balance and motor control.
3. Cranial manual therapy to improve the cranium mechanic.

Treatment prescribed:
1st session :Cranial manual therapy. During the session, patient reported warm in the tummy and numbness in both arms which patient did complain of when sleeping.
She was also advised to seek consultation from a neurologist.

Outcome from 1st treatment after 1 week:
1.patient reported that her gait has improved by 50%. Her children commented that she can walk straighter with better legs placement.
As for sit to stand, she doesn’t have any more problem
2. Single leg stance was possible for 4 sec.
3. Dysmetria signs also have slight improvement.
4. She also stopped having the warm feeling in her tummy and numbness in her hands at night.

She was diagnosed with a cerebellar cyst, just between the dura and arachnoid layers.A operation was performed this April and the cyst was totally removed.

However, she still has the same symptoms as pre op. Her headache had been constant and worst since. She has been attending physio and Occupational therapy for the last few months, working on her balance and cognition. All therapy has not work for her. The neuro doctor suggests steroid injection to the brain /spine and a lumbar puncture as the next treatment. The patient’s parents are not comfortable with that approach and look for alternative. They also stop attending therapy.

The young gal was referred to me this aug. On assessment, she had :
1. Tight left upper trap and scelenes ( the cranial incision was performed to the left temporal/occipital region)
2.listening of restriction in left sagital suture and falx tentorial

4 sessions of treatment were given from aug till today. Cranial treatment was prescribed to improve the saggital suture and cranial membrane. Mum was taught a simple “ear pull” technique as home exercise. Treatment was progressively positive at each visit.

Today, mum feedback that :
1. The young gal temper has improved and she is passing her math assessment in school.
2. There is no more headache since
3. Her balance is no longer an issue.

Last friday, on first assessment, she has:
1. Manual listening: restriction to the left mid tx dural
2. Anterior rotation of left temporal bone
3. Hypo mobility of left C1/2.
4. Tight left posterior scelene and elevated left 1st rib
5. Rotation of mid tx to the left
6. Ruled out of central and peripherial vestibular orgins

Rx for
1. Neural manipulation of the tx dural and falx tentorium
2. Temporal bone moblisation posteriorly
3. Spinal manipulation to the upper cx and tx spine
4. Fascial release of scelene.

Re assessment:
She felt less stiff in tx and neck. Isq for dizziness and walking

2nd session:
This am, she reported 80% improvement in her disability, one day post treatment till now. Only brought on dizziness if sudden motion