Progressive Vestibular Treatments for the over 60 population

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Why take this course?

Barry Morgan utilizes a very relaxed conversational style while instructing you in the core essentials of specific vestibular disorders, in the elderly population.

30 plus years of experience as a physical therapist provide insight into managing specific vestibular disorders for the aging population. A general discussion and overview of specific anatomical structures and physiological processes are reviewed as it relates to the material being presented. This intermediate level course provides a good explanation of particular ocular motor, vestibular and balance assessment tests in addition to progressive treatment solutions. The techniques are demonstrated in a case study format for the real-life application.


Details about this Online Continuing Education Course

This educator’s unique style definitely provides an insight not typically presented in online courses and encompasses many side conversations that build into the overall understanding of the material.

Understanding the fundamentals of how to perform specific tests and the reasoning for testing is essential information for any clinician to appropriately establish a comprehensive program in today’s healthcare environment. With limited time and visits, it is pertinent to have a good grasp of the appropriate tests to perform and treatments to utilize to reach a positive outcome. This course starts off with the fundamental question: What is dizziness and what can cause it? Discussion into the factors that can lead into a patient complaining of a feeling dizzy or “feeling just not right in the head?” will progress toward specific tests and treatments that are most beneficial in treating the “Dizzy, elderly population”. Expect to learn about the components involved in the ocular motor examination, how to perform the tests and treatment ideas to enhance function. Throughout the demonstrated exam, the instructor provides extensive scenarios on potential outcomes and how to progress with each one. This course is progressed with balance and BPPV testing and treatment.

This class is an excellent review for therapists who already have basic knowledge of the vestibular system. This course focuses on the evaluation and treatment of the elderly population. However, the tests and treatment methods can be applied to most vestibular patients. This course is applicable for PT, PTA, OT, and AT.

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  • CE Hours: 7 hrs
  • Delivered: Online
  • Instant Online Access, PDF Manual for Download, 365 days of access, Mobile Ready
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View PT, PTA, OT and ATC Continuing Education Course State Accreditation

Course Objectives

Course Objectives

Upon Successful Completion of this class, the participant will be able to:

  • Recognize anatomical and physiological factors that can lead to complaints of dizziness.
  • Discuss the potential underlying factors that can cause dizziness ranging from vestibular dysfunction, medication reactions to cardiovascular dysfunction.
  • Describe the four classifications of dizziness and the potential causes of dizziness in each group.
  • Describe the anatomy of the of the three distinct regions of the ear and identify the anatomical structures that play an essential role in equilibrium and sensing motion.
  • Describe the relationship between the semicircular canals and the otolith organs and identify how movements impact the specific canals.
  • Identify how balance and movement information is processed.
  • Perform a comprehensive evaluation that tests for ocular-motor, balance and vestibular function.
  • Recognize nystagmic variations and assist in the correct diagnosis.
  • Determine the specific tests to perform for BPPV and interpret the clinical findings to establish an individualized program.
  • Identify vestibular hypofunction vs. vestibular loss.
  • Recognize central disorders and associated symptoms
  • Recognize the role the therapist can have in treating Menier’s disease and hypofunction neuritis.
  • Identify appropriate evidence-based assessment tools that are used for assessing vestibular and balance dysfunction in the elderly population.
  • Test for eye movements to include saccades, smooth pursuits, nystagmus.
  • Describe the difference between physiological and end gaze nystagmus and how to appropriately evaluate for nystagmus so you don’t have a false positive test.
  • Perform VOR testing and discuss the one to one relationship of the VOR, the specifics of a phase or symmetry problem and in addition to clinical findings and treatment solutions.
  • Determine the appropriate time to use assessment tools and tests and when not to because it may cause more harm.
  • Recognize the underlying factors that can inhibit progression of vestibular rehab in the elderly population.
  • Develop a progressive treatment program for VOR work-ocular motor exercises.
  • Develop a comprehensive program that incorporates progressive activities to challenge balance in a variety of real-life settings.

Learn From the Expert - Barry Morgan, PT

Learn From the Expert - Barry Morgan, PT

Barry Morgan, PT received a BS degree in Anatomy from West Texas State University and a BS degree in Physical Therapy from the University of Texas. Since 1986, he has practiced in a variety of neurologic and orthopedic settings. He is currently working independently as a vestibular therapist and balance consultant in his own practice and has been a national seminar educator since 2003. He has extensive experience in the interpretation of vestibular testing, computerized balance testing, video nystagmography, and oculomotor testing. Barry finished a competency-based course on vestibular rehabilitation from Herdman in 2004. He is highly skilled in the evaluation and treatment of patients with vestibular disorders and concussion syndromes. He has worked closely with the U.S. Military treating returning injured soldiers with vestibular and concussion injuries. In addition, he treats concussion injuries in the athletic population. He was involved in an NIH grant study on motion illness in 2006 and has also published research on BPPV in the Neuro-Otology Journal in 2007. Current research interests include vestibular treatment algorithms for a variety of vestibular conditions and continued BPPV research. He has presented several community education courses on balance and fall prevention and has provided free screening services for many local health fairs attempting to raise the awareness for the need for proactive exercise for elderly abatement of dizziness and imbalance, and proper diagnosis of conditions involving the vestibular system.

General Discussion and Vestibular Overview

General Discussion and Vestibular Overview
  • The importance of anatomy and physiology knowledge
  • Common diagnoses pitfalls
  • Are they dizzy?
  • Are they imbalanced?
  • Do they have just gait dysfunction
  • Combinations of issues?
  • Where do your referral come from?
  • Generalized rehab, how do we do that?
  • What happens when they fall?
  • How is their gait affected?
  • What type of medication are they taking
  • A vague or floating sensation
  • I’m dizzy. How are you going to help me?
  • Partial vestibular-testing contribution
  • Common medications that act as vestibular suppressants

Anatomy and Physiology of the Vestibular System

Anatomy and Physiology of the Vestibular System
  • Basic Review of the anatomy of the ear
  • Outer ear-earlobe to the tympanic membrane
  • Middle ear-air-filled cavity
  • Inner ear-cochlear and vestibular system
  • The membranous labyrinth
  • Understaning the cochlea
  • The otolithic organs
  • Function of the semicircular canals
  • The utricle and the saccule
  • The perilymph fluid
  • Understanding the vestibular Nerve
  • Cranial Nerve VIII
  • Three planar, XYZ axes
  • The Physiology of BPPV
  • Central vestibular pathways
  • The vestibular nuclear complex
  • Cervicospinal reflexes
  • The vestibular nucleus of the complex of the pons
  • Oculomotor nuclei
  • The Cerebellum
  • Vestibulo-Collic reflex
  • Vestibulo-Spinal reflex
  • Vestibulo-Cortical reflex
  • Cervical Reflexes
  • Somatosensory reflexes
  • Dizziness and Ddisorientation
  • Maintaining a fixed gaze

Examination Components

Examination Components
  • Key components of the initial examination
  • Head Impulse Test
  • Head Shake Test

Symptoms Commonly Associated with Vestibular Dysfunction and the Clinical Presentation

Symptoms Commonly Associated with Vestibular Dysfunction and the Clinical Presentation
  • Discussion of common physical impairments seen with vestibular dysfunction

Case Study: 70 Year Old Female with a History of Falls and Complaints of Dizziness

Case Study: 70 Year Old Female with a History of Falls and Complaints of Dizziness
  • Testing for nystagmus
  • Saccadic ability
  • Defining physiological nystagmus
  • Pathologic nystagmus
  • Full range pursuits
  • Neck ROM
  • Speed of motion
  • VOR
  • Testing from sitting to stand
  • Balance Discussion of normal and abnormal findings
  • Understanding the implications of findings with specific static balance testing.
  • Discussion of balance testing, with or without shoes
  • Type of surface and impact on testing
  • Gait and balance assessment
  • Walking forward, side to side, backwards, eyes open, eyes closed, tandem walking.
  • Discussion of walking guidelines based upon findings
  • When an assistive device is needed
  • Learm how to challenge gait.
  • Head Impulse Test
  • Reasoning for not performing other specific tests
  • BPPV testing and discussion of clinical findings

Treatment-Ocular Motor Exercises

Treatment-Ocular Motor Exercises
  • Setting Up a Treatment for VOR Work-Ocular Motor Exercise
  • Ocular Motor Exercise and Head Movement
  • Ocular Motor Exercise and Head Movement with modifications to accommodate decreased neck ROM
  • Ocular motor drill progression parameters

Treatment-Progression of Activities to Challenge Balance and Gait

Treatment-Progression of Activities to Challenge Balance and Gait
  • Treatment techniques to improve balance
  • Advanced skills to improve balance
  • Advanced Gait and balance drills

Learn about BPPV

Learn about BPPV
  • Determining BPPV diagnosis
  • Tests to perform
  • Discussion and demonstrations of what is happening physiologically
  • Keys to appropriate testing
  • Treatment for posterior canal involvement
  • Demonstration of step by step BPPV techniques to decrease symptoms.
  • Demonstrating the Epley maneuver
  • Dix-Hallpike Maneuver
  • Discussion of progression of treatment
  • Discussion of other underlying conditions occurring concurrently with BPPV
  • Variant BPPV
  • Testing the horizontal canals
  • Discussion of positive signs and the specific symptoms of horizontal canal involvement
  • Treatment of horizontal canal involvement
  • BBQ roll technique demonstrated
  • Alternative testing positions for elderly clients

Hypofunction, Viral Neuritis, Vestibular Migraines, Meniere’s

Hypofunction, Viral Neuritis, Vestibular Migraines, Meniere’s
  • Discussion of other conditions that can lead to vestibular Symptoms to Include:
    • Viral neuritis
    • Meniere’s
    • Vestibular Migraines
    • Treatment options

Concussion and its physiological impact

Concussion and the impact on a patient
  • The three top symptoms across a 22-symptom scale
  • SCAT, Sport Concussion Assessment Tool

Course Test - Evaluate your knowledge

Course Test - Evaluate your knowledge
  • Use the Healthclick proprietary online education system which provides the online student with:
    • Worldwide access to high definition video, anatomical animations and images, and written information
    • The highest quality film in the industry, you can see the difference!
    • Stop and resume within a course, the Healthclick system will optimize your course based on your device, connection and remembers where you left off.
    • Real-time course updates. We are always adding to each courses, updating content, adding animations, these are not static courses!
  • Evaluate your knowledge with the course test on any device.
  • Print your state course certificate for CE credit.
  • Take the online test as many times as need in order to achieve a 70 % or greater score.