Using Differential Diagnosis to Evaluate the Dizzy Patient
There has been an explosion of new research and interest into dizziness, balance control, and the role of the vestibular system with various pathologies. Physical therapists now have a primary role in treating patients with dizziness caused by inner ear problems, TBI, concussion, migraine, and whiplash. This has created a new and unique patient population seeking physical therapy services. With the myriad of symptoms that can accompany dizziness, as a therapist, how do you make sense of it all?

The rehabilitation of the dizzy patient requires a thorough understanding of the causes of dizziness from a neurological and orthopedic perspective and the relationship between the vestibular system and other systems. This course will provide the knowledge to perform a thorough evaluation of the dizzy patient. Emphasis will be placed on the differential diagnosis process to identify the exact cause of dizziness. Lab sessions will focus on hands-on examination and treatment techniques. This course is a must for anyone treating patients with dizziness in their clinics.

Course Content

OVERVIEW OF DIZZINESS

u          Various causes

            •           multisystem deficit of aging

            •           inner ear

            •           syncope

            •           head injury

            •           psychiatric

THE ROLE OF THE VESTIBULAR SYSTEM

u          Anatomy and physiology

u          Pathophysiology and causes of dizziness from inner ear disorders

u          Benign Paroxysmal Positional Vertigo (BPPV)

u          Clinical examination and differential diagnosis

u          The role of nystagmus in identifying the cause

            •           how to interpret and describe nystagmus

u          The interrelationship between the cervical spine and vestibular system

            •           cervicogenic dizziness and whiplash

HANDS-ON LAB: THE VESTIBULAR ASSESSMENT

u          Specific how-to and red flags with taking history

u          Special tests including Dix-Hallpike, Roll Test, Head Impulse Test, and balance measures

u          Canalith Repositioning Treatment for treating BPPV

            •           BPPV variants and treatment

THE NEW REALM FOR THE THERAPIST: VESTIBULAR MIGRAINE

AND CONCUSSION

u          Pathophysiology and causes of migraine

u          How to identify the vestibular migraine

u          Treatment considerations including common pharmacotherapy

u          Concussion considerations with age

            •           the pediatric vs. adult athlete

u          Return to play considerations with concussion

            •           who makes the decision

            •           standardized testing

HANDS-ON LAB: EXERCISE PRESCRIPTION FOR THE

DIZZY PATIENT

u          Vestibular adaptation principles

            •           visual exercises

u          Balance retraining

            •           exercise progression and pitfalls

u          Techniques to reduce positional dizziness

u          Role of manual vs. vestibular therapy, or both?

DIFFERENTIAL DIAGNOSIS

u          Putting the examination together

            •           What does it mean? Red flags vs. red herrings

            •           case studies

*Course content is not intended for use outside of the scope of the participant's license.