Introduction to Vestibular Rehabilitation - Assessment and Treatment Strategies

COURSE DESCRIPTION

The Vestibular Disorders Association (VEDA) estimates that as many as 35% of adults over the age of 40 have experienced some form of vestibular dysfunction.  Dizziness and vertigo account for about 4 million emergency department visits annually in the United States, acute vestibular syndrome (AVS) accounts for 10-20% of these ED visits, another 4-6% of these patients are diagnosed with a cerebrovascular cause.  Therapists who are trained in evidence-based assessment techniques can assist not only to decrease unnecessary imaging and/or hospital admissions for patients with BPPV or other peripheral AVS disorders, but also help aide in the diagnostic process of identifying patients with acute posterior fossa CVA that may not be evident with early MRI.  Therapists who are trained in appropriate treatment of vestibular dysfunction can significantly impact patient outcomes; in fact, studies indicate that successful remission of the signs and symptoms of BPPV is obtained in 67-94% of all patients treated with canalith repositioning treatment (CRT), compared with 0%-48% for those given no treatment.

This hands-on course will provide participants with the knowledge and skill set necessary to understand the vestibular system and its role in balance and function.  Participants will learn signs and symptoms of common vestibular disorders and practice applying this knowledge using case studies and video demonstration.  This course is designed to provide participants with the knowledge to complete a basic examination of the vestibular system, identify a peripheral vs. a central cause of vertigo, and apply evidence-based treatment strategies aimed at reducing their patient’s symptoms and improving their overall function.  Lab instruction will compliment course content to help provide therapists with relevant clinical tools.

SPEAKER INFO:

Devon Gaydosh, PT, DPT has worked for OhioHealth at the Upper Arlington Outpatient Neurologic Rehabilitation Center as a member of the Brain & Stroke Rehabilitation and Vestibular/Balance team since May 2014. Prior to her time at OhioHealth, she worked for 4 years on the neurological and vestibular team for Kettering NeuroRehab and Balance Center in Dayton, Ohio. She graduated from Miami University in Oxford, OH with her Bachelor of Science in Health and Sports Studies in 2007 and from the University of Dayton with a Doctorate in Physical Therapy in 2010. Recent vestibular training includes virtual attendance at the 360 NeuroHealth Virtual Vestibular Summit and APTA CSM 2021 vestibular content. Devon pursued her passion for education by earning her Emory Vestibular Certification through the APTA and her Neuro-Developmental Treatment (NDT) certification. Devon belongs to the American Physical Therapy Association (APTA), is a Neurology section member, and is an APTA certified clinical instructor. She has been a primary clinical mentor for the Vestibular Module of the OhioHealth/Ohio University Neurologic Physical Therapy Residency Program since 2017.

Kara Rawlings PT, DPT, NCS is a Physical Therapist specializing in the assessment and treatment of patients with vestibular and neurological disorders.  She graduated from Ohio University’s Doctorate of Physical Therapy program in 2008 where she learned the basics of vestibular rehabilitation during both course work and clinical experiences.  Kara was awarded the Susan Herdman Certificate of Competency in Vestibular Rehabilitation in 2014 from Emory University.  Kara currently works at OhioHealth’s Riverside Methodist Hospital and has worked with other OhioHealth therapists to build a cross-continuum vestibular rehabilitation team with goals of improving patient identification and access to effective treatment.  Kara has instructed continuing education courses in vestibular rehabilitation and has served as a guest lecturer in physical therapy assistant programs in Ohio.  Kara is also a board certified clinical specialist in Neurologic Physical Therapy and is an APTA Credentialed Clinical Instructor.

Jodi A. Renard, PT, DPT, C/NDT received a B.S. in Allied Medical Professions with a major in Physical Therapy in 1995 from Ohio State University and her clinical doctorate degree from Shenandoah University in 2011. Recent vestibular training has included the APTA Concussion Course at CSM 2015 and University of Pittsburgh "Vestibular Rehabilitation:  An Advanced Course and Update" in May 2016. She was named a NDTA Inc., Adult Course PT Instructor in 2014 and Coordinator Instructor in 2019.  Jodi became a Certified Brain Injury Specialist in January of 2019.  She was a speaker on post-traumatic dizziness at the 2012 Brain Injury Summit, hosted by Craig Hospital in Beaver Creek, Colorado; The Grant Trauma Conference, Columbus, OH in 2013 and the OhioHealth Neuroscience Symposium, Columbus, OH in 2015. She has been a co-instructor of the OhioHealth Intro to Vestibular Rehab Course since 2016.  Jodi has served a Residency mentor for the Acquired Brain Injury module for the Ohio University – OhioHealth Physical Therapy Residency Program since 2017.  She belongs to the American Physical Therapy Association (APTA), is a Neurology section member, and is an APTA certified clinical instructor.  She specializes in the treatment of brain and stroke conditions and vestibular rehabilitation.  She has experience working with neurologically impaired clients along the continuum of care.  She currently works for the OhioHealth Outpatient Neurological Rehabilitation in Columbus, Ohio.

AGENDA:

DAY 1 (8:00-2:00 pm)

Introductions 5 minutes

Anatomy and Physiology of the Vestibular System (8:05 am – 8:35 am)

-Function of the vestibular system
-Peripheral anatomy and function
-Central projections
-Basic physiology of the peripheral and central vestibular system

Pathophysiology- Signs and Symptoms (8:35 am – 9:35 am )
-Identifying key items in a history or subjective assessment to help drive diagnosis
-Overview of BPPV
-Overview of other common disorders causing dizziness

10-minute break

Oculomotor assessment (9:45 am – 11:15 am)
-Peripheral vs. central etiology
-Differential diagnosis of unilateral or bilateral vestibular hypofunctions
-Video examples and case studies (differentiating central vs. peripheral)
-Hands-on lab – (oculomotor assessment)

Introduction to treatment Strategies for vestibular hypofunction (11:15 pm – 12:00pm)
-Adaptation Exercises
-Substitution Exercises
-Habituation Exercises

Lunch on own 12:00 pm-12:30 pm

Treatment strategies for vestibular hypofunction hands on lab (12:30 pm - 1:30 pm)

Questions/Case studies (1:30 pm – 2:00 pm)


DAY 2 (8 am – 3pm)
8:00 am – 11:15 am (15-minute break during this time)
Positional Testing
-BPPV
-Dix- Hallpike
-Side-lying test
-Roll Test
-Video examples and case studies

Treatment Strategies for BPPV
-CRT maneuvers for canalithiasis and cupulolithiasis of the anterior, posterior, and horizontal canals
-Habituation exercise option and forced prolonged positioning
-Hands-on lab - (BPPV assessment and CRT)

Cervico-genic dizziness (11:30 am – 12:00 pm)
-Overview of the pathophysiology of cervico-genic dizziness
-Specialized assessment techniques for cervical dysfunction
-Manual therapy techniques to address cervical spine dysfunction
-Treatment strategies incorporating adaptation, substitution, and proprioceptive exercises

Lunch on own 12:00 pm – 12:30 pm

The post-concussive patient (12:30 pm – 1:45 pm)
-Overview of the pathophysiology of concussion
-Through assessment of the post-concussive patient with dizziness
-Assessment of all aspects of impairments (emotional, cognitive, somatic)
-Treatment strategies to maximize function and return to sport – when to refer to specialist

Gait and Balance Assessment and Treatment Considerations (1:45 – 2:15 pm)
-Gait assessment with use of standardized measures
-Balance assessment with use of standardized measures
-Hands-on lab – Practice use of standardized assessment tools

Developing a plan of care and goal writing (2:15pm – 2:30 pm)
-Incorporating functional goals
-Making appropriate referrals
-Case studies and examples

Case studies/Questions – incorporating complex patient presentations and multi-canal BPPV (2:30 pm – 3:00 pm)

1. Identify key signs and symptoms in a subjective history to help guide assessment and differential diagnosis
2. Demonstrate use of oculomotor assessment and identify central vs peripheral findings.
3. Explain the appropriate treatment progression for a patient with a vestibular hypofunction.
4. Demonstrate proper techniques for assessment of BPPV and be able to localize the affected canal based on assessment findings.
5. Demonstrate proper technique for treatment of posterior canal, horizontal canal, and anterior canal canalithiasis and cupulolithiasis BPPV
6. Demonstrate knowledge of assessment and treatment techniques for the patient with post-concussive dizziness and cervico-genic dizziness
7. Demonstrate knowledge of the use of appropriate gait and balance assessments to assist in guiding treatment and patient goals.

REGISTRATION IS ONLY OPEN TO OHIOHEALTH-AFFILIATED PT/OT STAFF AT THIS TIME.  General registrants will be invited to register beginning in January if availability allows.

This course is nearly full.  If you attempt to register and are unable, please email [email protected] to be placed on a wait list.  

$125 for OhioHealth-affiliated PT/OT staff (OhioHealth, OHRH, NovaCare)

$250 for general registrants

Cancellation and Refund Policy: OhioHealth reserves the right to cancel or delay this course due to any unforeseen circumstances.  In the event this meeting would have to be canceled, OhioHealth will refund your registration fee.  We are not responsible for any travel, hotel, or other costs incurred.  If a participant cancels, refund of conference fee minus a 25% administrative charge will be made if written notice of cancellation is received no later than 2/5/2022.  If self-cancellation occurs as a result of COVID outbreak and written proof is provided (eg of work/local government travel restrictions, or doctor's note noting high risk), administrative charge may be waived.  No refunds will be granted after 2/5/2022 unless in the case of documented illness.