Dizziness and the Unbalanced Patient

Course Outline

Dizziness is one of the most common complaints reported to physicians. Symptoms of dizziness, vertigo, or imbalance are disabling and may result from stroke , head injury, infection, or medical debilitation. Patients are frequently referred to both orthopedic and neurologic clinics. This two-day course will provide detailed examination and intervention strategies to assist the practitioner in skilled assessment and treatment of dizziness and balance disorders. The course begins with discussion of the anatomy and physiology of movement perception and equilibrium. The clinician will gain a thorough understanding of various categories of dysfunction including cerviogenic, vestibular, and central nervous system disorders. Diagnostic tests and their interpretation are discussed and related to differential diagnosis techniques. The most current treatments are presented for Benign paroxysmal positional vertigo, and the attendee will have the opportunity to gain skill appropriately selecting and performing repositioning maneuvers. Cerviocogenic dizziness, cervical pathology, and the role of the cervical spine in spatial orientation and balance are described. Clinicians will obtain a thorough understanding of the foundation and relevance of vestibular rehabilitation therapy. A comprehensive multidimensional balance assessment and retraining program aimed at fall prevention is outlined in detail. Research based evidence and literature supporting treatment is reviewed. Hands-on laboratory sessions are combined with lecture to assist the learner in the practice and application of skills. Several case studies are provided as examples so the learner may synthesize and integrate course material into clinical decision making. Therapists will be able to immediately apply the skills learned in this course to clinical practice.


Course Objectives

• Describe the various etiologies of dizziness and balance disorders.
• Understand the anatomical and physiologic basis of movement perception and balance.
• Recognize the signs and symptoms that distinguish common diagnostic categories of vestibular, cervical, and central dysfunction.
• Define and describe the diagnostic criteria for cervicogenic dizziness.
• Effectively assess and treat benign paroxysmal positional vertigo using current treatment strategies.
• Describe diagnostic tests for dizziness and imbalance and their clinical relevance.
• Describe the multidimensional approach to an understanding of balance and fall prevention.
• Perform sensory and motor tests relating to postural control and fall assessment.
• Apply specific evaluative tests including oculomotor, visual-vestibular, motion sensitivity, and CTSIB.
• Develop an appropriate treatment plan to address vestibular impairments.
• Apply assessment and treatment strategies for cervicogenic dizziness.
• Distinguish patient impairment, set specific treatment goals, and be knowledgeable of reimbursement issues for the dizzy or unbalanced patient.

Schedule of instruction

  Day One   Day Two
7:30 8:00 Registration 8:00 10:00 Multidimensional Balance Treatment Plan (Lecture/Lab)
8:00 8:30 Introduction to the Dizziness and Disequilibrium   • Center of gravity control training
  • Prevalence of dizziness, statistics on falls   • Postural strategies
  • Etiologies of dizziness and balance disorders   • Multisensory training
  • Signs and symptoms of dysfunction   • Gait variability enhancement
8:30 10:00 Anatomy and Physiology of Move- ment Perception and Balance   • Fitness and Tai Chi balance
  • Dynamic Equilibrium model   • Motor control and learning
  • Peripheral vestibular anatomy 10:00 10:15 Break
  • Central nervous system connec tions and pathways 10:15 11:15 Vestibular Rehabilitation (Lecture/Lab)
10:00 10:15 Break   • Theoretical basis for recovery
10:15 11:15 Pathology of the Peripheral Vestibular System   • Retraining the VOR and VSR
  • Benign paraoxysmal positional vertigo (BPPV)   • Vestibular adaption, habituation and substitution strategies
  • Vestibular neuritis, labyrinthitis, acoustic neuroma, ototoxicity, perilymphatic fistula, endolym phatic hydrops, Meniere’s disease 11:15 12:00 Central Disorders
  • Bilateral disorders   • Central vestibular disorders
11:15 12:00 BPPV Treatment (Lecture/Lab)   • Cerebellar disorders
  • Differential canal involvement and variants   • Migraine and Mal De Debarquement
  • Dix-Hallpike, Brandt-Daroff, and Roll tests 12:00 1:00 Lunch (On Your Own)
  • Canalith repositioning maneuver for posterior and anterior canal 1:00 1:45 Cervicogenic Dizziness Assessment and Treatment
  • Liberatory, Semont, Appiani, Bar-B- Que Roll   • Neck torsion testing
  • Algorithm for treatment, modification   • Cervical kinesthesia re- education
  • Contraindications to assessment and treatment   • Cervical stabilization exercises
12:00 1:00 Lunch (On your Own)   • Manual therapy
1:00 1:30 Balance and Dizziness Assessment Introduction   • Precautions
  • Current literature and theories 1:45 3:00 Rehab management Considerations
  • Clinical presentation and differential diagnosis of dizziness related to cervical spine   • Identifying impairments
  • Determining when referral to another health care professional   • Establishing goals
  • Red flags   • Treatment progression strategies
1:30 3:00 Balance and Dizziness Assessment Introduction   • Psychological issues
  • Age related changes in balance   • Reimbursement issues
  • Critical and key components of patient history   • Equipment needs on budget
  • Multifactorial risk assessment   • Small group discussions
  • Diagnostic and vestibular function tests 3:00 3:15 Break
3:00 3:15 Break 3:15 3:45 New and Developing Treatment Approaches
3:15 4:00 Balance and Dizziness Assessment   • Space and motion sensitivity habituation
  • Vestibular system evaluation components   • New technologies
  • Balance and fall risk assessment   • Unclassified use of technology in the military
  • Computerized dynamic posturography   • Virtual reality environments
  • Differential Diagnosis, central vs. peripheral pathology 3:45 4:30 Case Studies Applications
4:00 5:00 Balance and Dizziness Assessment (Lab)   • Small group discussions
  • Oculomotor and visual vestibular. testing   • Questions and review
  • Tests of postural control, fall risk assessment    
  • CTSIB-analysis of sensory integra- tion    
  • Gait competency assessment    
5:00 5:30 Review and questions    

Downloads

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Course Brochure for Dizziness and the Unbalanced Patient

Scheduled Dates and Locations

Start DateEnd DateLocation - **Click to Map It**TuitionHrsHotel
Dec 06, 08Dec 07, 08Holy Cross Hospital, Ft. Lauderdale, FL$399.0018.00View Hotels

 

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Course Instructor
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Wendy Wood, MPT, is a physical therapist at a leading hospital based outpatient Balance and Vestibular Center in central California. Ms. Wood holds a competency based certification in vestibular rehabilitation. Additionally, she has been certified as a Balance and Mobility Specialist Instructor through the rigorous FallProofTM Program offered at California State University, Fullerton’s Center for Successful Aging. Ms. Wood has treated patients with dizziness and balance disorders in various settings including acute care, rehabilitation, outpatient orthopedic, long-term care, and assisted living facilities. She has treated patients of all ages including adolescents, professional athletes and geriatrics. She has assisted in developing vestibular rehabilitation programs at local clinics and has consulted with physicians on balance and vestibular disorders. Ms. Wood has taught nationally on vestibular rehabilitation, dizziness, and fall prevention. She is an Adjunct Instructor at Fresno City College’s Health and Science Division. Ms. Wood earned her Masters of Physical Therapy at California State University, Fresno. She is currently pursuing a doctorate of physical therapy through Temple University in Pennsylvania. She is member of the American Physical Therapy Association including the Vestibular Special Interest Group, and she is a professional member of VEDA, the Vestibular Disorders Association. Her interests include the integration of neurological science into neurorehabiliation and evidence-based research concerning new technologies to treat dizziness, spatial disorientation and balance.

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