Vestibular Continuing Education

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 a Vestibular Therapist

A vestibular therapist demonstrates techniques to effectively treat this population combined with information from the healthclick clinical team.

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

• 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

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

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

• 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

• 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 techniques to improve balance
• Advanced skills to improve balance
• Advanced Gait and balance drills

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

• 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

• The three top symptoms across a 22-symptom scale
• SCAT, Sport Concussion Assessment Tool

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.