Introduction to Vestibular Rehabilitation - Assessment and Treatment Strategies

Saturday, September 30, 2023, 8:00 AM - Sunday, October 1, 2023, 2:00 PM, OhioHealth Neurological Rehabilitation - Upper Arlington

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:

Aaron Cullen, PT, DPT, NCS is a physical therapist and rehab services program coordinator at Riverside Methodist Hospital.  He graduated from The Ohio State University with his DPT in 2015, and completed the OhioHealth/ Ohio University Neurologic PT residency in 2017.  He has served as a primary PT residency mentor in acute care focusing in neuroscience and neuroanatomy.  He is actively involved in the vestibular PT program at OhioHealth, serving as the leader of the inpatient vestibular system team and contributing member of the vestibular outcomes team. 

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.


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.

Abigail Uribe, PT, DPT received her B.S. in Exercise Science from Miami University in 2012 and her Doctorate in Physical Therapy from The Ohio State University in 2015. Abby began working for OhioHealth in May of 2015 with a career in outpatient orthopedics. She transitioned to outpatient neurologic rehabilitation in 2016 and is now a member of the Brain and Stroke Rehabilitation team and the Vestibular team at the OhioHealth Outpatient Neurological Rehabilitation clinic in Upper Arlington, Ohio. Abby furthered her knowledge of vestibular and neurologic rehabilitation by earning her Certificate in Vestibular Rehabilitation at Emory University in 2016 and her Neuro-Developmental Treatment (NDT) certification in 2017. Abby has served as a guest lecturer for the physical therapy assistant program at the Bradford School in Columbus, Ohio and she served as a course instructor for an Introduction to Vestibular Rehabilitation course in November of 2018 and a BPPV course in June of 2019. She belongs to the American Physical Therapy Association (APTA), is a Neurology section member, and is an APTA credentialed clinical instructor. Abby also serves as an adjunct clinical mentor for the OhioHealth/Ohio University Neurologic Physical Therapy Residency Program.

AGENDA:

DAY 1 (8:00-3:00 pm)

Introductions 5 minutes

Anatomy and Physiology of the Vestibular System (30 minutes)

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

Pathophysiology- Signs and Symptoms (30 minutes)
-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 (1.5 hours)
-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 (45 minutes)
-Adaptation Exercises
-Substitution Exercises
-Habituation Exercises

Lunch on own (30 minutes)
Treatment strategies for vestibular hypofunction hands on lab (1 hour)

Questions/Case studies (30 minutes)

DAY 2 (8 am – 2pm)
3 hours 15 minutes: (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 (30 minutes)

-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(30 minutes)

The post-concussive patient (1 hour 15 minutes)
-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 (30 minutes)
-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 (15 minutes)
-Incorporating functional goals
-Making appropriate referrals
-Case studies and examples

Case studies/Questions – incorporating complex patient presentations and multi-canal BPPV (30 minutes)

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

Cancellation and Refund Policy: OhioHealth reserves the right to cancel or delay a course due to any unforeseen circumstances. In the event a course is cancelled, OhioHealth will refund all registration fees. OhioHealth is not responsible for any travel, hotel or other costs incurred.
B. Participant Cancellation: If a participant cancels, a refund of the conference fee minus an administrative charge of 25% of the registration fee will be made if written notice of cancellation is received no later than one week prior to the event. Exceptions may be approved on a case-by-case basis.
C. Inclement Weather: If a participant is unable to attend due to inclement weather (Level 3 Snow Emergency), refund of the registration fee minus 25% administrative charge will be issued.
D. Exceptions: Exceptions are considered at the discretion of the primary activity planner on a case-by-case basis.

11.25 CEU's approved by the Ohio OTPTAT Board - OT section and by the Ohio Physical Therapy Association.

Ohio Occupational Therapy, Physical Therapy, and Athletic Trainers Board - OT Section (11.25 hours), Ohio Physical Therapy Association (11.25 hours)