The Dizzy and Imbalanced Patient:
Differential Diagnosis, Examination and Treatment
CEU credit: 1.575

Course Description: This course is aimed at physical therapists and physicians who are treating patients presenting with complaints of dizziness and/or balance problems.  The participant will be able to use the skills learned in this short course to differentiate between central and peripheral vestibular patients, treat those who are appropriate and refer those who are not. Lecture material is provided using a self-paced online course provided by Educata.com. (Skillworks course participants receive a 15% discount on this (and all other) Educata online courses). The online course is a prerequisite for attendance a the live hands-on lab course, where exam and treatment procedures are demonstrated and practiced.

The course begins with a discussion of normal postural control mechanisms and how dysfunctions in these mechanisms lead to patient complaints of dizziness, vertigo, loss of balance, difficulty walking and falls.  Clinical tests of vestibular function are discussed in the online course and practiced at the live course, and the significance of abnormal findings is related to subjective complaints.  The diagnosis of benign paroxysmal positional vertigo (BPPV) in its various forms is presented and treatment using the repositioning maneuvers practiced.  The theoretical basis for vestibular habituation exercise and fall prevention programs is presented, and guidelines for implementing each are given.  The recent literature will be reviewed which justifies the use of these programs in terms of efficacy.  Lab sessions allow for practice of examination and treatment skills. Use of videotaped patients and several case studies provide examples of common problems, their treatment and outcomes.

Our goal is that the participant will be able to use their new skills immediately upon returning to the clinic. Accordingly, the student-instructor ratio is kept low to allow for increased feedback and flexibility to meet the participants needs.

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Objectives

At the conclusion of this course, the participant will be able to:

1. Describe the possible cause of dizziness, vertigo and imbalance.
2. Recognize and differentiate between central and peripheral vestibular disorders, including benign paroxysmal positional vertigo (BPPV) and cervicogenic dizziness.
3. Discuss the theory behind vestibular habituation exercise therapy.
4. Describe typical tests of vestibular function and interpret common findings.
5. Perform a basic clinical examination of the dizzy patient and interpret the findings.
6. Perform a basic evaluation of balance under varying sensory conditions and interpret the findings.
7. Perform a basic evaluation of vertigo provocation and interpret the findings.
8. Given examination findings, develop an evidence-based treatment program for balance and dizziness, including BPPV, with measurable, functional outcomes.
9. Discuss the cervical contributions to vertigo.
10. Discuss the recent literature that describes the efficacy and outcomes of vestibular, balance and fall prevention programs.

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Course Schedule

Day 1 (Breaks each 1/2 Day) 8:00 8:30 9:00 11:00 The problem: dizziness and dysequilibrium Patient cases (small groups) Dizziness Assessment: Clinical tests for central and peripheral vestibular function Diagnostic tests and interpretation   12:00 Lunch 1:00 2:00   4:00 Assessment of Postural Control and Fall Risk CTSIB: Classic Test for Sensory Integration and Balance; Posturography Interpretation of sensory integration tests: Patterns of dysfunction Cervicogenic dizziness   Day 2 8:00 9:00 10:15 11:00 Management Strategies; Theoretical basis for Vestibular Rehabilitation, Guidelines for Vertigo Treatment; Progression Variables Balance Treatment Decision tree; Balance exercises; Fall prevention Treatment of BPPV: CRM, liberatory maneuvers 12:00      Lunch 1:00 3:00   Treatment of BPPV (cont) Treatment concepts, cervicogenic dizziness