Spinning Beyond Basics - An Advanced Vestibular Rehabilitation Course

Course Outline

This two-day advanced course is designed for physical or occupational therapists, who have prior experience in vestibular rehabilitation and are seeking to refine their clinical evaluation and treatment skills beyond the basics. Therapists who are comfortable with their fundamental skills will find this course helpful at adding more treatment options to successfully treat the complex dizzy patient. Patient diagnoses discussed will include cervical dizziness, atypical BPPV, anxiety, migraine, acoustic neuroma, superior canal dehiscence, conversion disorder, and mal de debarquement. Focus will be placed on case study applications with careful analysis of history, diagnostic clinical findings, and classification of dysfunctions to allow optimal customized treatment protocols. Clinical skills to be taught will include fistula screening, cervicogenic screening, BPPV treatments beyond the posterior canal (anterior/horizontal canals), acoustic neuroma management including exposure to facial rehabilitation techniques, migraine screening and treatments, and identification/management of psychological factors. All testing and treatment protocols presented will be evidence-based and clinically relevant to more effectively managing the dizzy patient. Lectures will intersperse the refining of clinical testing protocols with specific treatment strategies for a wide range of diagnoses. Instruction will be provided via lecture, videotapes, lab breakouts, detailed demonstrations and case studies. Each participant will receive a comprehensive manual giving details of all recommended testing and treatment protocols.


Course Objectives

• Identify signs and symptoms that differentiate the diagnostic groups of BPPV, cervical dysfunction, psychogenic, meniere’s disease, and migraine.
• Learn appropriate examination procedures to distinguish between the diagnostic groups of BPPV, cervical, psychogenic, meniere’s disease, and migraine.
• Learn customized exercise protocols for each of the diagnostic groups of BPPV, cervical, psychogenic, meniere’s’s disease, and migraine.
• Identify psychological problems that can affect the management of vestibular problems and learn how to modify treatment intervention, plan, and goals.
• Learn to identify role of Migraine as both primary (causing of distinct vertigious episodes) and secondary (traditional migraines leading to more persistent motion. intolerance) contributor to dizziness and it’s impact on rehabilitation.
• Develop an understanding of the important role of both the medical and rehabilitative aspects managing dizziness and when to refer to another provider.
• Increase your repetoire of balance facilitation techniques both for motoric and sensory balance deficits with the dizzy patient.
• Further refine your skills related to the “fine art” of vestibular rehabilitation which is the accurate interpretation of eye motion as it relates to the patients clinical presentation.
• Develop improved management skills for patients with post surgical acoustic neuroma disability including fundamental skills related to facial rehabilitation, expected outcomes, and headache incidence.
• Identify the clinical presentation and learn clinical testing of patients with superior canal dehiscence (fistula) and current management.
• Further your understanding of clinical presentation of patients with Mal de Debarquement, current theories pathophysiology, and current recommended management strategies.

Schedule of instruction

  Day One   Day Two
7:30 8:00 Registration 7:30 8:15 Initial Evaluation Demonstration
8:00 10:15 Introduction and Conceptual Framework   • Observe complete examination
  • Overview of dizziness statistics   • Integrate/apply clinical evaluation
  • Review of key components of vestibular anatomy and physiology important to the understanding of clinical testing and treatment 8:15 10:15 Identifying and Treating Fluctuating Vestibular Disorders
10:15 10:30 Break   • Pathophysiology, clinical presentation, and treatment strategies of migraine and migraine associated dizziness including conservative treatment options and treatment for visual motion sensitivity
10:30 12:00 Understanding Diagnostics and Vestibular Pathology   • Clinical presentation and treatment strategies of Menier’s disease
  • Critical findings and implications of key diagnostic tests
-ENG, Rotary Chair, Computerized dynamic posturography, VEMP		   • Differentiating Meniers versus migraine and the important role of therapy sequential clinical testing
  • Key clinical features of each of the common vestibular pathologies   • Clinical presentation of fistula, both endolymphatic and superior canal dehiscence
12:00 1:00 Lunch (on your own)   • Fistula screening (Lab)
1:00 2:30 Critical Clinical Examinations 10:15 10:30 Break
  • Review critical clinical or bedside vestibular revaluations skills (gaze, spontaneous/positional nystagmus, head thrust testing (beyond just horizontal), CTSIB sensory testing, Frenzel lense examination, vestibular-specific gait testing 10:30 11:15 Managing Post-Surgical and Stable Vestibular Lesions (Lecture/Lab)
  • Optimizing your skills, techniques, and interpretation of each of the clinical tests   • Surgical options and clinical course of recovery of Acoustic neuromas
  • Reliability, validity, and limitations of each specific tests   • Post surgical consulting
2:30 3:30 Identifying and Treating Cervicogenic Dizziness (Lecture)   • Headache incidence and management
  • Identifying key history/ clinical findings   • Applicationand progression of VOR adaptation exercise routine and vestibular balance/gait retraining protocols
  • Criteria for diagnosis cervical dizziness 11:15 12:00 Introduction to Facial Rehabilitation
  • Overview of rehabilitation techniques   • Identifying stages of injury and recovery of facial nerve
3:30 3:45 Break   • Clinical rating scales available (House-Brackmann, Facial Grading Score, Facial Disability Index)
3:45 5:15 Cervicogenic Dizziness (Lab)   • Strategies for acute care of eye
  • Neck torsion testing   • Implications for and concepts behind facial rehab
  • Cranial base and occipital nerve entrapment screening 12:00 12:30 Lunch (on your own)
  • Cervicocephalic kinesthesia re- education exercises 12:30 1:15 Identifying and Treatment of Central Pathologies
  • Applying cervical stabilization exercises to the dizzy patient   • MS test findings
5:15 5:45 Update on BPPV testing (Lecture)   • Brainstem
  • Most up to date treatment options for all types of BPPV   • Central eye motion patterns
  • Infrared Frenzel lense analysis of eye movements   • Balance retraining strategies including facilitating motor recovery strategy recovery
  • Discussion on BPPV “superstitions” 1:15 2:00 Considerations for the “Rocking” Patient
  • Determining when positional vertigo is not BPPV   • Understanding Mal de Debarquement and conversion disorders
5:45 6:30 • Liberatory/canalith reposition for horizontal and anterior canals   • Incidence and pathophysiology of Mal de Debarquement
  • Teaching and prescribing self canalith repositioning maneuvers   • Treatment options Conversion disorder-theory considerations
    2:00 2:15 Break
    2:15 3:00 Identifying and Treating Psychological Disorders
      • Screening for anxiety and understanding panic attacks
      • Incidence and prevalence of psych overlay
      • Modifying treatment for anxiety
      • Applying relaxation strategies
      • Applying vestibular rehabilitation (habituation, adaptation, and balance retraining) to patient’s with psychogenic factors)
    3:00 3:15 Questions and Answers

Downloads

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Course Brochure for Spinning Beyond Basics - An Advanced Vestibular Rehabilitation Course

Scheduled Dates and Locations

Start DateEnd DateLocation - **Click to Map It**TuitionHrsHotel
Jan 10, 09Jan 11, 09San Ramon Regional Medical Center, San Ramon, CA$425.0015.00View Hotels
May 02, 09May 03, 09Alamance Regional Medical Center, Burlington, NC$425.0015.00View Hotels
Aug 22, 09Aug 23, 09Providence Portland Medical Center, Portland, OR$425.0015.00View Hotels
Oct 31, 09Nov 01, 09Tampa General Hospital, Tampa, FL$425.0019.00View Hotels

 

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Course Instructor
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Janene Burton Holmberg, PT, NCS received her BS degree in physical therapy from the University of Utah in 1987, and became an ABPTS board certified Neurological Clinical Specialist in 1996, with Recertification obtained in 2006. She is currently the coordinator of balance rehabilitation and hearing center in Utah. Janene serves as an adjunct faculty member at the University of Utah Physical Therapy Program, and is the Specialist for the Facial Disorders Center of the University of Utah School of Medicine. Her initial clinical work included an emphasis in stroke and brain injury rehabilitation. She completed her certification in NDT (Neuro Development Technique) in 1990. Since 1990, she has specialized primarily in Vestibular Rehabilitation and more recently Facial Rehabilitation. Janene is a member of the APTA Neurology Section’s Vestibular Special Interest Group and the Vestibular Disorders Association. She has lectured nationally with many leaders in this field including Dr. Rose, Dr. Robert Brey, Dr. Neil Shepard, Dr. Joel Goebel, Dr. David Cyr, and Dr. Nashner. She lectured for 3 consecutive years at the annual international meeting “Interdisciplinary Diagnostic and Rehabilitation Aspects of Balance Disorders” on the uses and applications of Center of Gravity Biofeedback. She has been a key note speaker for the American Academy of Audiologist (AAA) for the last two years lecturing on Vestibular Rehabilitation and particularly treatment protocols for Benign Positional Vertigo. Janene was the key note speaker in the Utah Chapter APTA annual conference in 2000. Since 1998, she has taught many courses in “Vestibular Rehabilitation” and “Falling in the Elderly” across the nation. She completed clinical competency in Biofeedback in 1991 and specialized training from Jackie Diels, OTR, in Facial Rehabilitation in 1996. She is currently collecting clinical outcome data on effectiveness of Vestibular and Facial Rehabilitation. Her current clinical practice consists of a broad scope of neurologic patients and she draws on her extensive experience to help clinicians learn to manage these challenging patients.

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