2016 OPTA East Central District CE Course: Vestibular Screening and Treatment in Therapy Practice: When to Refer

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What:           Seven Hour Continuing Education Course:

Vestibular Screening and Treatment in Therapy Practice: When to Refer

Where:         Walsh University

When:           December 3, 2016- 8:00-4:30

Who:              PTs and PTAs

Instructor:   Andy Beltz, PT, Vestibular Therapist and Principal Investigator

Skill level:     There will be basic, intermediate and advanced concepts reviewed. This course is ideal for therapists who want to assess and expand their skills helping clients who are battling dizziness.

Course Description

Vestibular Screening and Treatment in Rehab Settings: When to Refer is ideal for therapists who want to assess and expand their skills helping clients who are battling dizziness.

●       You are evaluating a 45-year-old male for headaches, neck pain, and dizziness and he suddenly develops severe spinning and vomiting. What should you do next?

●       A 68-year-old male has worked with you three visits on improving his balance and has made minimal progress.  Are there any simple bedside tests that could be done to confirm the presence of a vestibular dysfunction?  Would this individual benefit from vestibular exercises?

●        A 72-year-old female, who is status post two weeks left total knee arthroplasty, refuses to lie down to perform her exercises for fear of becoming dizzy.  She also becomes very dizzy sitting up.  Is there something more you could do to help?

With over 435 different words and phrases clients have used to describe dizziness, finding relief can sometimes be frustrating. In addition, therapists may not always know when to try to help or refer them to a vestibular specialist.  These case studies, combined with video analysis, will be reviewed to build skills relating to screening, evaluation, and treatment of the most common vestibular disorders.  A discussion regarding when to refer clients to other practitioners will take place.

Course objectives:

Upon completion of this seminar, the attendee will be able to:

1.      List the four most important goals for the clinician screening a client with dizziness.

2.      Define acute vestibular syndrome (AVS).

3.      Name three bedside tests that, when used together, may be more sensitive than MRI at identifying an acute posterior stroke.

4.      Recognize necessary clinical skills and tools needed to identify and treat a vestibular hypofunction.

5.      Describe how to evaluate and treat the most basic form of benign paroxysmal positional vertigo (BPPV).

6.      Compare and contrast the screening process for orthostatic hypotension (OH) and BPPV.

7.      Explain when the four types of vestibular rehabilitation should be utilized.

8.      Discuss when clients should be referred to vestibular specialty clinics and other specialists.

Time Schedule With Objectives

Topic	Time
Vestibular Rehab Overview:  Upon completion of this section, the learner will be able to: ●     Identify when vestibular rehab and/or other types of treatment options are needed. ●     List the four most important goals for the clinician screening a client with dizziness. Dizziness History: Upon completion of this section, the learner will be able to: ●     Name key questions needed to compartmentalize client’s symptoms and guide prediction of outcomes with vestibular rehab (VR). ●     Learn how to identify individuals who may be likely to vomit during the vestibular exam/treatment. ●     Learn how to identify the "highly sensitive person" before it's too late. ●     Recognize the importance of understanding the "trap of IT" during the history. ●     Discuss the need to learn each individual’s unique “dizzy language.”	8:00-9:00
Vestibular History and Exam: Upon completion of this segment the learner will be able to: ●     Compare stages of blizzards and tornadoes with common vestibular disorders and discuss how timing of testing and treatment impact outcomes.  ●     Define acute vestibular syndrome and how it relates to “The Dizzy Pit.” ●     Name questions helpful in predicting those at risk for vertebral artery dissection and/or stroke.  ●     Name three bedside tests that, when used together, may be more sensitive than MRI at identifying an acute posterior stroke. ●     List some of the most common causes of a vestibular hypofunction. ●     Recognize necessary clinical skills and tools needed to identify and treat a vestibular hypofunction. ●     Describe how to name nystagmus. ●     Discuss when clients should be referred to vestibular specialty clinics and other specialists.	9:00-10:00
Break	10:00-10:15
Vestibular Exam: Upon completion of this segment the learner will be able to: ●     Name various stages in which a vertebral artery dissection may present in your setting. ●     Discuss and demonstrate ways to identify stroke through the "HINTS" test battery. ●     Discuss Horner's sign and it's implications. ●     Name tests helpful for identifying "the highly sensitive person." ●     Explain how Alexander’s law is helpful in predicting outcomes.	10:15-11:15
Vestibular Exam and Treatment ●     Name and perform key bedside tests helpful for identifying a vestibular hypofunction. (Head Impulse, Mastoid Vibration, Dynamic Visual Acuity Test, Spontaneous and Gaze Hold Nystagmus Tests) ●     Discuss and demonstrate seven key elements helpful when implementing a vestibular rehabilitation program (treatment options). ●     List key coaching and education elements required to maximize outcomes.	11:15-12:15
Lunch	12:15-1:15
Benign Paroxysmal Positional Vertigo (BPPV) Vs. Orthostatic Hypotension (OH): Going Beyond, “What do you mean by dizzy?” ●       Describe how to set the most sensitive trap for identifying the presence of BPPV and/or OH in your clients. ●       Compare and contrast the screening process for OH and BPPV.	1:15-2:15
BPPV- From Captivity To Freedom: ●       Name and perform key tests helpful for identifying posterior canal BPPV. ●       Name and perform key tests helpful for identifying lateral canal BPPV. Demonstrate modifications that can be made for testing individuals with stiff spines.  ●       Demonstrate ways to confirm presence of BPPV if history is consistent with BPPV, but no signs exist during exam. ●       Describe likelihood for secondary BPPV in presence of other vestibular disorders. ●       Discuss when avoidance should be taught in treatment of BPPV. ●       Recognize how to Identify and treat the "rebellious" BPPV cases. ●       Demonstrate new treatment options for lateral canal BPPV. ●       Discuss when the Brandt Daroff exercise is indicated. ●       Recognize benefits of certain medications when treating some forms of BPPV.	2:15-3:15
Break	3:15-3:30
Vestibular Rehab Treatment: Upon completion of this segment, the learner will be able to: ●     Explain when the four types of vestibular rehabilitation should be utilized. ●     Discuss impact of sympathetic and parasympathetic nervous system imbalance on vestibular rehab prognosis. ●     Describe techniques available to optimize nervous system health. ●     Discuss modifications needed when planning treatment for the Highly Sensitive Person and Type A personalities. ●     Draw graphs that assist in recognizing how to plan treatments of clients battling dizziness ●     Discuss impact of identifying individuals "adaptive reserve" when planning treatments.	3:30-4:30

About the Speaker:

Andy Beltz, Physical Therapist, has specialized in helping thousands of clients battle disorders causing dizziness since May of 2000 at the Aultman Health Foundation in Canton, Ohio.  Since 2001, he has used infrared lenses (device used to study eye movements in the dark) and has been a vestibular specialty clinical instructor/capstone supervisor for 16 PT students in the outpatient setting.  He leads a vestibular rehab observation program that has served over 60 Medical Residents and has taught continuing education courses on vestibular rehabilitation since 2003.  As the principal investigator (ClinicalTrials.gov Identifier: NCT02626052), he has enrolled over 216 clients in his diagnostic accuracy study comparing room light and fixation blocked vestibular tests. He is a mentor for a concussion study being conducted by one of his peers, serves as chair-elect on Aultman’s Research Council, and is an adjunct faculty member for Aultman’s Research Academy.   He has passed two of Dr. Susan Herdman’s competency based courses (Vestibular Rehab and Vestibular Function Test Interpretation and Application to Rehabilitation).  He currently works full time as the therapy lead with a great team of colleagues at Aultman Tusc Therapy.  Mr. Beltz graduated from Bowling Green State University in consortium with The Medical College of Ohio (now University of Toledo) with his bachelor’s degree in physical therapy in 1999. He began working in acute care at Aultman in November of 1999 and has practiced vestibular rehab in all therapy settings.   He has been a member of the APTA since 1997.