Physical Therapy 
Education Specialists
 

Cervicogenic Dizziness: An Evidence-based Competency Course


Instructor: Robert Landel, PT, DPT, OCS, CSCS
Other instructors will be added as needed to maintain a low student to teacher ratio.

Co-sponsors: The American Physical Therapy Association, Emory University, and Skill Works

"I got sick to my stomach when he told me his symptoms of dizziness were all but gone with the transverse ligament test. With the education that I received from your course, I understood the significance of the results of this test and was able to effectively relay it to the doctor, thankfully. The course has been a big asset to my practice and I'm very glad that I was able to attend. Thank you!!!!"
    -- Donna Sibbach, PT

"I'm thrilled with how much I use the techniques! In fact, about a week after the class I helped a patient who had been dealing with dizziness for 2 years. It scared me at first because it was like waking a sleeping giant after my initial treatment and I was nervous she wouldn't come back...but it didn't take long for her to get relief!"
-- Lindsey Hejlek, PT

Course Created: 2004
Level:
Intermediate
Audience:
Physical Therapists

CEU credit:
2.025
 

Registration Fee (as of May, 2011; subject to change)
  • APTA Member: US$575
  • Non-APTA member: US$675

Course Description


One of the five courses that make up the Vestibular Rehabilitation Competency Course series founded by Susan Herdman, PT, PhD, this course focuses on the relationship between cervical sensorimotor and musculoskeletal disorders and patient complaints of vertigo and dizziness.

It is intended for physical therapists who have experience in managing patients with dizziness but wish to improve their skill in the differential diagnosis, manual examination and intervention of those patients whose dizziness has a cervicogenic component. A working knowledge of central and peripheral vestibular disorders and their various presentations is therefore a recommended pre-requisite. Management of dizziness and vertigo will be discussed from an interdisciplinary viewpoint. The neurologic therapist treating patients with primary diagnoses of vestibular dysfunction will learn to recognize coexisting musculoskeletal impairments. Similarly, the orthopedic therapist will be able to differentiate manifestations of dizziness due to non-musculoskeletal causes. Lab sessions will focus on screening for central and peripheral vestibular problems, assessment of the cervical spine with specific attention paid to potential causes of dizziness, and intervention strategies.

The emphasis of this course is on evidence-based practice and competency testing for knowledge and skill. With that in mind, pre-assigned readings will familiarize the participant with the relevant literature, allowing the majority of time and emphasis to be on practicing motor skills. Competency in these skills will be tested through oral and practical examinations.

This course differs from others in its focus on the orthopedic manual physical therapy skills that are useful in managing cervicogenic dizziness. Therapists will be able to immediately apply these skills in the clinical setting.

The course begins on Friday evening with a discussion of the evidence regarding the existence and presentation of cervicogenic dizziness. A method for differentiating cervicogenic causes from other causes of dizziness will be presented. Saturday morning will begin with a written examination. Lab sessions on Saturday and Sunday will allow practice of examination and intervention skills. Each day will conclude with a practical exam. Participants who pass all exams (>75% score) will receive a certificate of competency.

"My patients are loving the joint position error laser activities and cervical proprioceptive training!!! Your feedback was very helpful.
--Susan Nowak, PT, North Carolina

 "I really enjoyed the course! I particularly liked how you gave immediate feedback – I saw that you were concerned that we correctly learned to assess and perform techniques.

The reference studies that were reviewed by the students before the class provided the foundation for course. I completely appreciate your example of holding PT’s to a higher standard – like physicians- to be able to back up what we say with valid evidence. Higher expectations and standards will lead to a higher level of practice
.
 
I learned much from your presentation and feedback strategies."
-- Brian Arakaki, PT, California



Objectives

At the conclusion of this course, the participant will be able to:
  1. Discuss the literature relevant to the etiology, diagnosis and management of cervicogenic dizziness.
  2. Recognize the clinical presentation of cervicogenic dizziness, and differentiate it from other causes of dizziness.
  3. Determine when referral to another health care provider is warranted.
  4. Perform a physical examination of the cervical spine relevant to cervicogenic dizziness, and interpret the results.
  5. Design, perform and teach an appropriate intervention program to address the deficiencies that a person with cervicogenic dizziness might have.
  6. Perform manual interventions to the cervical spine that are appropriate for cervicogenic dizziness



Sample Course Schedule
Start Times vary depending on course location; confirmation of start times will be sent prior to course.
A sample course schedule is provided below.


Friday
(breaks given each 1/2 day)

2:00 Registration
3:00-7:00 Lecture: Cervicogenic Dizziness: the evidence, the controversy.
    Differential diagnosis of cervicogenic dizziness
    History: Identification of red flags
    Review of Pre-assigned readings: Q & A
   
Saturday
8:00       
Review: Central and Peripheral Vestibular Examination
9:15
Physical Examination of the C-spine
    * Upper cervical hypermobility
    * AROM: hypothesizing location of movement restrictions
    * VBI vs. BPPV
12:00
Lunch (OYO)
1:00
LAB: Passive movement testing
4:00
Written Test on Readings, Friday lecture
Practice time 1
5:30
Competency testing: Physical Exam

Sunday
8:00   
Manual intervention
    * Joint mobilization
    * Soft tissue intervention
    * Traction
    * Exercise intervention & Home program
12:00
Practice time and Lunch (OYO)
1:30
Competency testing: Intervention

 
 
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