This evidence-based course which combines both interactive lecture and lab will review the function, normal anatomy and physiology, and common pathologies of the vestibular system as well as the latest information and research regarding concussion. Course content also includes education for in depth assessment of common vestibular conditions; both acute and chronic and post concussive syndrome as well as treatment strategies and expected outcomes for these conditions. At the conclusion of this seminar, attendees will be able to perform a comprehensive evaluation with interpretation and be able to establish an effective treatment program based on their findings. This course is effective for any therapist working with patients that have balance deficits, difficulty ambulating, poor exercise tolerance, headaches and other symptoms associated with concussion, and/or dizzy complaints. Although the presentation of material is appropriate for clinicians that have limited experience treating the concussed patient and/or the patient with vestibular loss; it includes some more advanced assessment and treatment material that will appeal to clinicians that have experience with the population. This course is appropriate for practitioners that are interested in investigating why a patient falls, what causes their dizziness, the effects of a concussion, how to progress a patient to return to prior level of function and return to play as appropriate, and how the clinician can make a difference in the patient’s overall function by assessing and treating possible vestibular deficits in the concussed and non-concussed patient. This course is an excellent jumping point to start treating your patients more effectively and efficiently with evidence-based outcomes.

COURSE OBJECTIVES:

• Explain in simple terms the anatomy and physiology of the vestibular system.
• Perform specific tests to assess a patient’s vestibular loss and physical deficits related to concussion.
• Demonstrate an oculomotor exam.
• Differentiate between central and peripheral lesions of the vestibular system.
• Perform specific tests to assess balance and gait in a functional manner.
• Recognize common presentations of nystagmus and their relevance to treatment. 
• Design and provide rationale for an appropriate treatment plan including measurable goals. 
• Apply appropriate therapeutic interventions for various vestibular dysfunction and complications related to concussion.

GG1980

2 Posts
 
Posted - 04/30/2008 :  15:23:04  Show Profile  Reply with Quote
I have a patient that I think may have BPPV. The problem is she can not tolerate being put into supine or sidelying position for testing or for treatment. She experiences increase sx and severe anxiety. SOT positive on airdex. VOR positive for in phase and out of phase. Treated 4-5 patients in the past with BPPV and have 100% success rate. Stumped as far as what to do here as patient doesn't tolerate. Any suggestions would be appreciated.

JPT

2 Posts
 
Posted - 04/30/2008 :  17:39:05  Show Profile  Reply with Quote
Maybe you can try having two therapists treat the patient at the same time. One on each side. This may give the patient more sense of security and stability. Much encouragement will be required and it will be awhile before patient will trust you..

GG1980

2 Posts
 
Posted - 05/07/2008 :  17:48:38  Show Profile  Reply with Quote
Just saw my patient yesterday. At time of eval I had patient perform a modified Brandt-Daroff in sitting for HEP as she didn't tol sidelying or supine. This worked!! She reports decrease vertigo with sleeping and sit to stand transfers. She was even able to tol the Epley's technique today although I had to perform the maneuver slower than usual. Will keep everyone updated on my patient's progress. Thanks JPT for your suggestion.

MilwPT

7 Posts
 
Posted - 07/09/2007 :  14:16:56  Show Profile  Reply with Quote
Does anyone have a good Vestibular Evaluation form they could share? I have seen many different, but they seem to not be organized and have either too much or too little info on them. So I always just end of writing it all out an a standard eval form, and it gets messy. thanks!

georgeu

6 Posts
 
Posted - 07/27/2007 :  11:52:56  Show Profile  Reply with Quote
Here are some great links for assisting you in dx vestibular dysfunctions:
http://www.utmb.edu/otoref/Grnds/Vestibular-051214/Vestibular-051214.htm
http://www.aafp.org/afp/20060115/244.html

I'll see if I can get you a copy of the eval via email.
Go to Top of Page

georgeu

6 Posts
 
Posted - 08/03/2007 :  15:04:38  Show Profile  Reply with Quote
Here is a vestibular eval in MS word we use. You can adjust A & P based on your S & O.
http://www.cyberpt.com/documents/Vestibular%20Eval.doc

PTZ

1 Posts
 
Posted - 04/07/2006 :  00:28:35  Show Profile  Reply with Quote
I was just wondering what the most up to date directions are to give patients after performing the Epley Maneuver to treat BPPV? Some say sleep in recliner for 2+ days while others say 1 day is enough. Any other findings or updates would be appreciated.

georgeu

6 Posts
 
Posted - 04/08/2006 :  11:48:25  Show Profile  Reply with Quote
This is what I am telling patients after performing Epley or Sermont Maneuvers:
1) Wait for 10 minutes after the maneuver is performed before going home. This is to avoid "quick spins", or brief bursts of vertigo as debris re-positions itself immediately after the maneuver. Don't drive yourself home. Have someone ele drive you.
2) Sleep semi-recumbent for the next two days. This means you sleep with yo head halfway between flat and upright (a 45 degree angle). This is most easily done by using a recliner chair or by using pillows arrnaged on a couch. During the day, try to keep your head vertical. You must not go to the hairdresser or dentist. No exercise which requires head movement. When men shave under their chins, they should bend their bodies forward in order to keep their head vertical. If eyedrops are required, try to put them in without tilting the head back. Shampoo only under the shower.
3) For at least 1 week, avoid provoking head positions that might bring this on again.
Use two pillows when you sleep.
Avoid sleeping on the "bad" side.
Don't turn your head far up or far down.
Be careful to avoid head-extended positions, in which you are lying on your back, especailly with your head towards the bad side.
4) At one week after treatment, put yourself in the position that usually makes you dizzy. Position yourself cautiously and under conditions which you can't fall or hurt yourself. Let your doctor know how you did.
What if the maneuver doesn't work? These maneuvers don't always work (only 80% of the time), and if they don't, then your doctor may wish you to proceed with the Brandt-Daroff exercises. If a maneuver works but symptoms recur or the response is only partial, another trial of the maneuver may be advised.

MilwPT

7 Posts
 
Posted - 10/11/2006 :  20:57:32  Show Profile  Reply with Quote
I work with a neurologist and treat a lot of BPPV patients. I have my patients wear a soft collar for a few days after treatment, to avoid head movements. This seems to be pretty effective.

MGold

3 Posts
 
Posted - 02/20/2006 :  14:32:03  Show Profile  Reply with Quote
Just wondering if anyone out there had a good evaluation form for evaluating an individual with a vestibular disorder? I have a patient later on this week that is suppose to have BPPV. Our clinic doesn't have a form so I want to develop one. Thanks

georgeu

6 Posts
 
Posted - 02/20/2006 :  15:55:14  Show Profile  Reply with Quote
Here is an example of a SOAP note for a vestibular eval that I have on MS Word file. I simply get the required info and fill in later on the computer. Hope this helps.

BPPV EVAL EXAMPLE
S: Patient is a R handed female who reports insidious onset of sx beginning about 3 months ago. States 1st noticed her sx when she was lying in her bed and turned her head. States her condition has not improved since onset. States has had various tests performed and was diagnosed with BPPV Symptomology: Patient c/o of dizziness and a mild nauseous sensation with positional changes. States her sx would usually last no longer than about 3 seconds. Reports cervical rotation to the R is usually worse. Denies any pain, vision or hearing problems Psychosocial: Pt performs an office job. Reports increase sx/difficulty with getting in/out of bed, rolling in bed, bending down and getting back up, performing sit ups and scanning her environment quickly. C/o of increase sx with watching trains and other objects in motion PMH: sinuses, hypothyroid, heart palpitations, acid reflux, gall bladder surgery, appendectomy, hysterectomy Medications: atenolol, nexium, K+, water pill, lovoxol
O: Observation: mod endomorph, R shoulder lower than L, increase lumbar lordosis Shoulder Girdle AROM: WNL FWD & BWD circles GH AROM: WNL B GH flexion and abduction
Cervcial AROM Resistance
Flexion 75° mild sx coming back up 5/5
Extension 65° mild sx coming back 5/5
Side Bend R 55° 5/5
Side Bend L 55° 5/5
Rotation L 75° 5/5
Rotation R 75° 5/5

Eye-Head Movement Results (normal, abnormal, blurred vision, dizziness…..)
Smooth Pursuit WNL
Scanning WNL
Saccades WNL
VOR- Head moving, stationary object WNL
VOR- Head moving, object moving in-phase WNL
VOR- Head moving, object moving out-of-phase WNL
Visual Fields R peripheral visual field slightly deviated vs. L
Postural Control: SOT: 1) firm surface, eyes open- WNL (able to stand > 1 min without dev), 2) firm surface, eyes closed WNL (able to stand > 1 min but reports feeling fairly unsteady) 3) compliant surface, eyes open WNL (able to stand > 1 min but displays min sway) 4) complaint surface, eyes closed WNL (able to stand 1 min but displays mod sway) Sharpened Rhomberg: 30secs WNL, eyes closed 8 secs before LOB and c/o of mild dizziness and nausea Tandem Walking (25ft): WNL Functional Reach: WNL, Walking with Saccades Vertical and Horizontal: WNL Balance Strategies Used: utilizes hip and ankle strategies Special Tests: Hallpike-Dix Test + R (nystagmus < 30secs), Sidelying Test + with head rotated L and trunk SB R Rx Today/Patient Education: Patient educated on BPPV. Patient received treatment for BPPV R consisting of Epley’s technique. After treatment patient instructed to keep head upright even during sleep for 48 hours and then not to sleep on affected ear until follow-up assessment 1 week later.
A: Patient displays signs and sx consistent of BPPV R. Patient also displays increase reliance on vision for balance suggesting decrease somatosensory and vestibular systems as well. Goals (2-4) wks: 1) patient reports no episode of dizziness and nauseous sensation with position changes 2) patient independent with HEP and management of condition
P: Patient to be seen 1-2 x wk for 2-4 wks for BPPV treatment strategies. Thank you for your referral.

MGold

3 Posts
 
Posted - 02/20/2006 :  20:58:48  Show Profile  Reply with Quote
Thanks for the example. It will be real helpful.