Evaluation and Treatment of Bilateral Benign Paroxysmal Positional. Vertigo in a Patient Sustaining a Trauma to the Occiput: A Case.
|
|
- Marilyn Patterson
- 7 years ago
- Views:
Transcription
1 Evaluation and Treatment of Bilateral Benign Paroxysmal Positional Vertigo in a Patient Sustaining a Trauma to the Occiput: A Case Report Thomas G. Lavosky, PT, Cert. MDT Widener University Chester, PA PT 913 Paul Vidal, DPT
2 Introduction: Symptoms of peripheral vestibular disorders include vertigo, disequilibrium, and frequently nausea, and emesis. The most common cause of vertigo due to peripheral vestibular disorders is benign paroxysmal positional vertigo (BPPV). 1 BPPV is characterized by complaints of brief periodic vertigo when the head is moved into certain positions. The most prevalent etiology of this disorder is idiopathic (>50%) followed by post-traumatic (14-27%). 2 Other causes include labyrinthitis, vertebral-basilar ischemia, Meniere s disease, chronic otitis, and ototoxicity. 2 Patients with post-traumatic BPPV have a significantly higher incidence of bilateral involvement than do those with idiopathic BPPV. In addition, BPPV may present bilaterally in 7.5 to 15% of all cases. 3 There are two commonly accepted theories as to the cause of BBPV. The first theory, cupulolithiasis, proposes that otoconia from the maccule of the utricle becomes adhered to the cupula in one of the semi-circular canals, 4 usually the posterior canal. The increased density of the attached otoconia to the cupula produces excessive deflection when the patient s head is moved into certain positions, hence bringing on symptoms. Resulting nystagmus and vertigo is sustained as long as the patient s head remains in the provoking position. This form of BPPV is rare. The second theory, canalithiasis, proposes that dislodged
3 otoconia from the utricle is free floating in the endolymphatic fluid in one of the semi-circular canals, 5,6 usually the posterior canal. When the head is moved into a provoking position, the otoconia moves into the most dependent position in the canal. This results in a movement of endolymph and thus a deflection of the cupula. The vertigo and nystagmus occur with a1 to 40 seconds latency after the patient is placed in a provoking position. The symptoms initially increase and then resolve within 60 seconds. The symptoms usually fatigue if the patient is repeatedly placed into the provoking position. BPPV resulting from canalithiasis is the most common form. Involvement of the posterior, anterior, or horizontal canal can occur with BPPV. The posterior canal is involved the most frequently followed by the anterior and horizontal canals (Figure1 and 2). 7 The direction of the nystagmus when the patient is moved into the provoking position indicates which canal is involved. The most commonly used test to confirm the diagnosis of BPPV with posterior or anterior canal involvement is the Hallpike-Dix test. 8 According to Lopez-Escamez et al, 9 the Hallpike-Dix test has a sensitivity of 82% and a specificity of 71%, thus it is effective in ruling out and in BPPV involving the anterior or posterior canal. The positive and negative likelihood ratios are 2.8 and.25, respectively. 9 The gold standard in this study was defined as independent selection of the same diagnostic category by all three investigators after examining a questionnaire regarding each patient s history. The roll test is used to detect BPPV with horizontal canal involvement.
4 Figure 1 The treatment of choice for posterior or anterior canalithiasis is the canalith repositioning technique (CRT). During this technique it is theorized that canalith moves out of semi-circular canal into the common crus and finally into the vestibule. Figure 2
5 For cupulolithiasis involving the posterior or anterior canal the treatment of choice is the liberatory maneuver. Finally, the treatment of choice for horizontal canalisthiasis and cupulolithiasis are the CRT horizontal canal and the Brandt- Daroff exercises, respectively. 10 Studies focused on the outcome of CRT, including several randomized control trials, have shown success rates of > 60% after a single treatment and of > 95% after 3 treatments. 11 Ostensibly, because of multiple canal involvement with bilateral BPPV, usually more than one CRT is necessary for complete or substantial resolution of symptoms. The presence of bilateral disease has a statistically significant influence on the number of treatments necessary for the relief of symptoms (P<.05). 12 There are infrequent cases, however, where resolution occurs after performing the CRT on the more symptomatic side only. Kaplan et al 13 reported successful management of patients with bilateral BPPV by performing the CRT on the more symptomatic side first; i.e., the side that has nystagmus of faster and higher amplitude. After the Hallpike-Dix test is negative on this side, the CRT is performed on the contralateral side.
6 The purpose of this case study is to discuss the management and outcome of a patient with bilateral BPPV using the CRT, gaze stabilization exercises, and static and dynamic balance exercises. A CAT scan ruled out disequilibrium resulting from a cerebellum or a brain stem lesion.
7 Description of Subject: The patient is a 51-year old male with chief complaints of 4-month history of vertigo, disequilibrium, tinnitus, inability to smell, and headaches resulting from hitting the back of his head after falling from a ladder. He reported that he fractured his skull and had bleeding from the nose and ears after the injury. Precipitating factors for vertigo and disequilibrium included transferring from sitting to standing, looking up, and laughing. In addition, he stated that the duration of the dizziness was less than one minute. A CAT scan did not reveal a brain stem, cerebral, or cerebellar lesion. Plain film radiographs revealed a fractured occiput. An audiography did not reveal a loss of hearing. Examination: On initial evaluation, objective findings were as follows: no spontaneous or gazeevoked nystagmus, normal smooth pursuits in the horizontal plane with production of dizziness after 7 second, normal smooth pursuits in the vertical plane with production of dizziness after 10 second, normal saccadic tracking in horizontal plane with production of dizziness after 5 seconds, production of oscillopsia after 7 seconds with vestibular ocular reflex (VOR) in horizontal plane, normal VOR in the vertical plane, negative right and left head thrust, no nystagmus post head-shaking in horizontal and vertical planes (Frenzel lenses were not used), valsalva maneuver produced head pain but no dizziness, performed Romberg stance for > 30 seconds with eyes open and with eyes closed with minimal sway, performed sharpened Romberg stance with eyes open
8 for > 30 seconds with minimal sway, performed sharpened Romberg stance with eyes closed for 20 seconds with severe sway, performed 4 consecutive tandem steps with eyes open, periodic staggering with walking with head rotation every 5 th step, positive right and left Hallpike-Dix maneuver producing right and left torsional nystagmus, respectively. The right side was more symptomatic. Up beating and down beating nystagmus were not detected because of fixation suppression of vertical nystagmus as the result of performing the Hallpike-Dix without Frenzel lenses. 10 The latency and duration of the nystagmus (5 seconds and 15 seconds, respectively), and concurrent vertigo, was consistent with BPPV (canalithiasis) with involvement of the posterior or anterior semi-circular canal. Description of Intervention: On 6/8, two days after the initial evaluation a CRT was performed on the right side. (This technique was not performed during the initial evaluation because I had not treated a patient with bilateral BPPV before and wished to consult with a physical therapist at NYU vestibular department before I proceeded). The patient was instructed to wear a cervical spine collar, to avoid tilting his head up or down, and to sleep supine on extra pillows to keep his head elevated at night for a period of 48 hours. In addition, he was advised not to sleep on his right side for 5-days. During his follow-up visit on 6/13, the right Hallpike-Dix did not produce nystagmus or vertigo. The left Hallpike-Dix, however, produced (L) torsional nystagmus with concurrent vertigo. On 6/22, a CRT on the left side was performed and the patient was given post CRT instructions as above. Upon re-
9 evaluation 6/26, the right and left Hallpike-Dix were negative for production of nystagmus and vertigo. During the four visits from 6/29 to 7/13, visual-vestibular exercises were initiated and progressed (smooth pursuits active eye movements between two targets VOR I and II exercises in sitting VOR I and II exercises in standing VOR I exercise in standing with word on checker board background VOR I while standing on foam with word checker board background VOR I while walking with word on checker board background). During this period, static and dynamic balance exercises were also initiated and progressed (sharpened Romberg stance with eye close marching on foam with eyes open upper extremity side to side ball toss with visual tracking while standing on foam forward and backward tandem walking with eyes open walking while moving head right-upward and left-downward every 3 steps and vise versa). Outcomes: Upon discharge on 7/13, objective findings were as follows: no production of dizziness with smooth pursuits in vertical or horizontal plane, no production of oscillopsia with VOR in horizontal plane while focusing on a V with a checker board background for > 45 seconds, performed sharpened Romberg with eyes closed for > 30 seconds with minimal sway, normal reach test, negative Singleton s test, performed 10 consecutive tandem steps with eyes open, unable to perform tandem walking with eyes closed, and no intermittent staggering while walking with rotating head every 5 th step. He reported that he no longer had
10 vertigo or disequilibrium, but continued to complain of an inability to smell and tinnitus. (Although I did not formally re-test and record static and dynamic balance and gaze stabilization after performing the CRT, they had improved but were still impaired. Therefore, I would conclude that BPPV was partially responsible for balance and visual deficits.) Discussion: Although it cannot be directly shown that the CRT actually moves canalith out of the semi-circular canal into the common crus and finally into the vestibule, this is a plausible explanation in this patient since his symptoms of vertigo resolved shortly after performing the maneuver. The CAT scan ruled out disequilibrium resulting from a cerebellum or a brain stem lesion. The patient s gaze instability and disequilibrium might have been caused by the co-morbidity of vestibular hypofunction notwithstanding a negative post head shaking nystagmus and head thrust test. The sensitivity of the head-shaking test in patient s with unilateral or asymmetrical vestibular hypofunction is decreased when frenzel lenses are not used because of fixation suppression of horizontal nystagmus. 14 In addition, the head thrust and is less sensitive in detecting hypofunction in patients with incomplete loss of peripheral vestibular function. The sensitivity of the head thrust test with incomplete and complete unilateral vestibular hypofunction is 58% and 88%, respectively. 15 The sensitivity of the head thrust test with incomplete and complete bilateral vestibular hypofunction is 76% and 100%, respectively. 15 The gold standard was an abnormal caloric or rotary chair test. 15 Perhaps the
11 Fukuda s stepping test should have been included in the examination, for patients with unilateral vestibular hypofunction often turn excessively toward the involved side when their eyes are closed, whereas patients with bilateral vestibular hypofunction typically fall or translate forward during this test. 10 If vestibular hypofunction was a co-morbidity in this patient, the VOR and VSR exercises may have facilitated adaptation within the CNS and resolved the disequilibrium and restored gaze stability. Disequilibrium, however, is more severe in bilateral as compared to unilateral BPPV even in the absence of a comorbidity, possibly causing a continuous, generalized imbalance between classic bouts. 13 To obtain a better quantitative measure of the patient s pre and post intervention function, the dizziness handicap inventory should have been administered. This questionnaire provides a reliable, valid, and sensitive measurement of a patient s perception of the effects of dizziness and unsteadiness. 16 Since BPPV is considered the most common cause of vertigo, it is incumbent of physical therapists to be proficient in the assessment and treatment of this peripheral vestibular disorder.
12 References 1. Froehling DA, et al: Benign positional vertigo: Incidence and prognosis in a population-based study in Olmsted county, Minnesota. Mayo Clin Proc. 1991;66: Baloh, RW, et al: Benign positional vertigo: Clinical and oculographic features in 240 cases. Neurology. 1987;37: Katsaakas A. Benign paroxymal positional vertigo (BPPV): idiopathic versus post-traumatic. Acta Otolaryngol.1999;119: Schuknecht HF. Cupulolithiasis. Arch otolaryngol. 1969;90: Epley JM. The canalith repositioning procedure for treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 1992;107: Hall SF, Ruby RR, McClure J. The mechanisms of benign paroxysmal vertigo. J Otolaryngol. 1979;8: Herdman SJ, et al. Eye movement sings in vertical canal benign paroxysmal positional vertigo. In Fuchs, AF, et al (eds): Contemporary ocular motor and vestibular research: A tribute to David S. Robinson. Stuttgart, Thieme, 1994, pp Dix MR, Hallpike CS. Pathology, symptomatology and diagnosis of certain disorders of the vestibular system. Proc Roy Soc Med. 1952; 45: Lopez-Escamez JA, et al. Diagnosis of common causes of vertigo using a structured clinical history. Acta Otorrinolaringol Esp. 2000;51(1):25-30.
13 10. Herdman SJ. Vestibular Rehabilitation. 2 nd ed. Philadelphia, PA: FA Davis Company, Epley JM. The canalith repositioning procedure for treatment of benign paroxysmal positional vertigo. Otolaryngol Head neck surg. 1992;107: Marcias JD. Variables affecting treatment in benign paroxysmal positional vertigo. Laryngoscope. 2000;110(11): Kaplan DM et al. Management of bilateral benign paroxymal positional vertigo. Otolaryngology-Head and Neck Surgery. 2005;133: Watabe V, Hashiba M, Baba S. Voluntary suppression of caloric nystagmus under fixation of imaginary of after-image target. Acta Otolaryngol Suppl. 1996;525: Schubert MC, Tusa RJ, Grine LE, Herdman SJ. Optimizing the sensitivity of the head thrust test for identifying vestibular hypofunction. Physical Therapy. 2004;84(2): Jacobson GP, Newman CW. The development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg. 1990;116:
Benign Paroxysmal Positional Vertigo. By Mick Benson
Benign Paroxysmal Positional Vertigo By Mick Benson Definition Benign - not life-threatening Paroxysmal - a sudden onset Positional - response provoked by change in head position Vertigo - sensation of
More informationVestibular Rehabilitation Therapy. Melissa Nelson
Vestibular Rehabilitation Therapy Melissa Nelson What is Vestibular Rehabilitation Therapy (VRT)? VRT is an exercise-based program designed to promote CNS compensation for inner ear deficits. The goal
More informationProposed Treatment for Vestibular Dysfunction in Dogs By Margaret Kraeling, DPT, CCRT
Proposed Treatment for Vestibular Dysfunction in Dogs By Margaret Kraeling, DPT, CCRT Vestibular dysfunction in the dog can be a disturbing condition for owners, as well as somewhat confounding for the
More informationVestibular Assessment
Oculomotor Examination A. Tests performed in room light Vestibular Assessment 1. Spontaneous nystagmus 2. Gaze holding nystagmus 3. Skew deviation 4. Vergence 5. Decreased vestibular ocular reflex i. Head
More informationBenign paroxysmal positional vertigo (BPPV) is. Systematic approach to benign paroxysmal positional vertigo in the elderly
Systematic approach to benign paroxysmal positional vertigo in the elderly SIMON I. ANGELI, MD, ROSE HAWLEY, PT, and ORLANDO GOMEZ, PHD, Miami and Jupiter, Florida OBJECTIVE: We evaluated the effectiveness
More informationSpeaker: Shayla Moore, BMR(PT) Relationship with commercial interests: Employee at Creekside Physiotherapy Clinic
Speaker: Shayla Moore, BMR(PT) Relationship with commercial interests: Employee at Creekside Physiotherapy Clinic 1 Vestibular Rehabilitation Managing dizziness to maintain mobility in the elderly" Dizziness:
More informationBenign Paroxysmal Nystagmus (BPN)
Benign Paroxysmal Nystagmus (BPN) AKA: Benign Paroxysmal Positional Nystagmus (BPPN) Benign Paroxysmal Positional Vertigo (BPPV) Benign Positional Vertigo (BPV) Brief attacks of rotatory vertigo +/- nausea
More informationThe Role of Physical Therapy in Post Concussion Management. Non Disclosure
The Role of Physical Therapy in Post Concussion Management. Cook Children s Sports Medicine Symposium Ryan Blankenship, PT, SCS Non Disclosure No conflicts of interest. 1 Course Objectives Participants
More informationVestibular Rehabilitation What s the Spin?
Vestibular Rehabilitation What s the Spin? Carolyn Tassini, PT, DPT, NCS Vestibular Certified Rehabilitation Supervisor Bancroft NeuroRehab Objectives Attendees demonstrate a basic understanding of the
More informationObjectives. Early Detection of Vestibular Dysfunction. Early Detection of Vestibular Disorders in Individuals with Brain Injury
Early Detection of Vestibular Disorders in Individuals with Brain Injury Jordana Gracenin PT, DPT Sara Schwartz PT, DPT, NCS Objectives 1. The learner will be able to identify anatomy and physiology of
More informationBalance and Vestibular Center Programs to treat dizziness and reduce your risk of falling
Balance and Vestibular Center Programs to treat dizziness and reduce your risk of falling Helping you overcome dizziness and vertigo Most people will experience dizziness at some point in their lives.
More informationVestibular Rehabilitation
PO BOX 13305 PORTLAND, OR 97213 FAX: (503) 229-8064 (800) 837-8428 INFO@VESTIBULAR.ORG WWW.VESTIBULAR.ORG Vestibular Rehabilitation An Effective, Evidence-Based Treatment By Anne Shumway-Cook, PT, PhD;
More informationOtologic (Ear) Dizziness. Fistula Other. SCD Bilateral. Neuritis. Positional Vertigo BPPV. Menieres
Otologic Dizziness (Dizziness from Ear) Ear Structures of importance Timothy C. Hain, MD Northwestern University, Chicago t-hain@northwestern.edu The ear is an inertial navigation device Semicircular Canals
More informationPresented by: Paul G. Vidal, PT, MHSc, DPT, OCS, FAAOMPT Specialized Physical Therapy, LLC 2015 AOASM Annual Clinical Conference Philadelphia, PA
Presented by: Paul G. Vidal, PT, MHSc, DPT, OCS, FAAOMPT Specialized Physical Therapy, LLC 2015 AOASM Annual Clinical Conference Philadelphia, PA Concussion The Role of the Physical Therapist Valuable
More informationBenign Paroxysmal Positional Vertigo David Solomon, MD, PhD
Benign Paroxysmal Positional Vertigo David Solomon, MD, PhD Address Department of Neurology, University of Pennsylvania, 3 W. Gates Building, 3400 Spruce Street, Philadelphia, PA 19104-4283, USA. Email:
More informationAnterior semicircular canal benign paroxysmal positional vertigo and positional downbeating nystagmus
American Journal of Otolaryngology Head and Neck Medicine and Surgery 27 (2006) 173 178 www.elsevier.com/locate/amjoto Anterior semicircular canal benign paroxysmal positional vertigo and positional downbeating
More informationConcussion/MTBI Certification Series. Featuring: Frederick R Carrick, DC, PhD Distinguished Professor of Neurology, Life University
Concussion/MTBI Certification Series Featuring: Frederick R Carrick, DC, PhD Distinguished Professor of Neurology, Life University Please note that spaces are limited for this specialty certification program.
More informationIntroduction to Dizziness and the Vestibular System
Introduction to Dizziness and the Vestibular System David R Friedland, MD, PhD Professor and Vice-Chairman Chief, Division of Otology and Neuro-otologic Skull Base Surgery Chief, Division of Research Department
More informationA Flow Chart For Classification Of Nystagmus
A Flow Chart For Classification Of Nystagmus Is fixation impaired because of a slow drift, or an intrusive saccade, away from the target? If a slow drift is culprit Jerk Pendular Unidrectional (constant
More informationBALANCE AND VESTIBULAR REHABILITATION THERAPY MANUAL
BALANCE AND VESTIBULAR REHABILITATION THERAPY MANUAL Copyright AMERICAN HEARING & BALANCE CENTERS, INC., 2010 2010 Revision 3.01 TABLE OF CONTENTS Description Page Five Indications For Therapy... 1 Treatments
More informationDefinition of Positional Vertigo. Positional Vertigo. Head r.e. Gravity. Frames of reference. Case SH. Dix Hallpike was positive
Positional Vertigo Definition of Positional Vertigo Timothy C. Hain, MD Departments of Neurology, Otolaryngology and Physical Therapy Northwestern University, Chicago, IL Sensation of motion Elicited by
More informationPost-Concussion Syndrome
Post-Concussion Syndrome Anatomy of the injury: The brain is a soft delicate structure encased in our skull, which protects it from external damage. It is suspended within the skull in a liquid called
More informationVestibular Rehabilitation: A Competency-Based Course
Vestibular Rehabilitation: A Competency-Based Course Emory Conference Center and Hotel 1615 Clifton Road, NE Atlanta, Georgia 30329 Course Description This intense, evidence- based, six- day course is
More informationVestibular Rehabilitation: A Competency-Based Course
Vestibular Rehabilitation: A Competency-Based Course Emory Conference Center and Hotel 1615 Clifton Road, NE Atlanta, Georgia 30329 Course Description This intense, evidence- based, six- day course is
More informationDizziness: More than BPPV or Meniere s. William J Garvis, MD Otology, Neurotology & Skull Base Surgery Ear, Nose & Throat SpecialtyCare of MN, PA
Dizziness: More than BPPV or Meniere s William J Garvis, MD Otology, Neurotology & Skull Base Surgery Ear, Nose & Throat SpecialtyCare of MN, PA American Family Physician Dizziness: A Diagnostic Approach
More informationBenign Paroxysmal Positional Vertigo (BPPV)
Benign Paroxysmal Positional Vertigo (BPPV) UHN Information for Patients Patient Education Improving Health Through Education You have been told by your doctor that you have Benign Paroxysmal Positional
More informationDIAGNOSIS AND TREATMENT OF BPPV FOR PHYSICAL THERAPY
DIAGNOSIS AND TREATMENT OF BPPV FOR PHYSICAL THERAPY DISCLOSURES JAMES R. BARSKY PT, DPT CHESTNUT HILL HOSPITAL NEUROLOGY, PSYCHIATRY AND BALANCE THERAPY CENTER None Pennsylvania Physical Therapy Association
More informationDizziness and Vertigo
Dizziness and Vertigo Introduction When you are dizzy, you may feel lightheaded or lose your balance. If you also feel that the room is spinning, you may have vertigo. Vertigo is a type of severe dizziness.
More informationThe Human Balance System
PO BOX 13305 PORTLAND, OR 97213 FAX: (503) 229-8064 (800) 837-8428 INFO@VESTIBULAR.ORG WWW.VESTIBULAR.ORG The Human Balance System A Complex Coordination of Central and Peripheral Systems By the Vestibular
More informationPediatric Vestibular Assessment for Children Who Are Deaf or Hard of Hearing
Kristen Janky, Au.D., Ph.D., CCC-A Vestibular Audiologist Vestibular Services, Clinical Coordinator Pediatric Vestibular Assessment for Children Who Are Deaf or Hard of Hearing Kristen Janky Au.D., Ph.D.,
More informationLess common vestibular disorders presenting with funny turns
Less common vestibular disorders presenting with funny turns Charlotte Agrup, Department of Neuro-otology, The National Hospital for Neurology and Neurosurgery, London Making the diagnosis Making the diagnosis
More informationThe Human Balance System
5018 NE 15 TH AVE PORTLAND, OR 97211 FAX: (503) 229-8064 (800) 837-8428 INFO@VESTIBULAR.ORG VESTIBULAR.ORG The Human Balance System A Complex Coordination of Central and Peripheral Systems By the Vestibular
More informationV~stibular Rehabilitation: Critical Decision Analysis
V~stibular Rehabilitation: Critical Decision Analysis Richard E. Gans, Ph.D., FAAA, ABSTRACT Vestibular Rehabilitation Therapy (VRT) is used by audiologists, physical and occupational therapists, and physicians
More informationBenign Paroxysmal Positional Vertigo (BPPV)
PO Box 13305 Portland, OR 97213 fax: (503) 229-8064 (800) 837-8428 INFO@VESTIBULAR.ORG WWW.VESTIBULAR.ORG Benign Paroxysmal Positional Vertigo (BPPV) By Timothy C. Hain, MD, Northwestern University Medical
More informationWorkup and Management of Vertigo
Workup and Management of Vertigo S. Andrew Josephson, MD Department of Neurology University of California San Francisco October 25, 2008 The speaker has no disclosures Two Key Questions 1. What do you
More informationII. VESTIBULAR SYSTEM OVERVIEW
HM513 Vertigo and Dizziness; Vestibular System Disorders - Summary Eric Eggenberger*, DO and Kathryn Lovell, PhD *Co-Director, MSU Neuro-Visual Unit; *Director, MSU Ocular Motility Lab Department of Neurology
More informationWhiplash injuries can be visible by functional magnetic resonance imaging. Pain Research and Management Autumn 2006; Vol. 11, No. 3, pp.
Whiplash injuries can be visible by functional magnetic resonance imaging 1 Bengt H Johansson, MD FROM ABSTRACT: Pain Research and Management Autumn 2006; Vol. 11, No. 3, pp. 197-199 Whiplash trauma can
More informationGAZE STABILIZATION SYSTEMS Vestibular Ocular Reflex (VOR) Purpose of VOR Chief function is to stabilize gaze during locomotion. Acuity declines if
GAZE STABILIZATION SYSTEMS Vestibular Ocular Reflex (VOR) Purpose of VOR Chief function is to stabilize gaze during locomotion. Acuity declines if slip exceeds 3-5 deg/sec. Ex: Head bobbing and heel strike
More informationBalance and Aging By Charlotte Shupert, PhD, with contributions by Fay Horak, PhD, PT Oregon Health & Science University, Portland, Oregon
PO BOX 13305 PORTLAND, OR 97213 FAX: (503) 229-8064 (800) 837-8428 INFO@VESTIBULAR.ORG WWW.VESTIBULAR.ORG Balance and Aging By Charlotte Shupert, PhD, with contributions by Fay Horak, PhD, PT Oregon Health
More informationBaseline Shift and Gain Asymmetry in the Caloric Test
i n p r a c t i c e F O R C L I N I C A L A U D I O L O G Y March 2010 Baseline Shift and Gain Asymmetry in the Caloric Test Kamran Barin, Ph.D. Biography: Kamran Barin, Ph.D., is Director of Balance Disorders
More informationDizziness and Vertigo: Emergencies and Management
Dizziness and Vertigo: Emergencies and Management Ronald J. Tusa, MD, PhD a, *, Russell Gore, MD b KEYWORDS Vertigo Dizziness Vestibular Imbalance Emergency room Nystagmus A 49-year-old woman is brought
More informationThe Dizzy and Imbalanced Patient Part II: Evaluation
The Dizzy and Imbalanced Patient Part II: Evaluation Rob Landel PT, DPT, OCS, CSCS Note to Participants: There are interactive pop-up questions throughout this lecture. If you choose to pause the lecture
More informationLecture Plan. Anatomy and Pathophysiology of the Vestibular System. Vestibular Overview. Vestibular Physiology. Vestibulo-ocular reflex V.O.R.
Anatomy and Pathophysiology of the Vestibular System Lecture Plan 1. Vestibular Physiology 2. Anatomy and clinical syndromes Timothy C. Hain, MD Vestibular Physiology Vestibular Overview Vestibular sensors
More informationHandicap after acute whiplash injury A 1-year prospective study of risk factors
1 Handicap after acute whiplash injury A 1-year prospective study of risk factors Neurology 2001;56:1637-1643 (June 26, 2001) Helge Kasch, MD, PhD; Flemming W Bach, MD, PhD; Troels S Jensen, MD, PhD From
More informationIt was really affecting my quality of life and my ability to sleep, the 72-year-old Bend woman said.
Curing vertigo Markian Hawryluk / The Bulletin Published Oct 14, 2010 at 05:00AM For several months last year, Sonja Decker had to lie down to sleep with the utmost caution. If she rolled over on to her
More informationPrimary Motor Pathway
Understanding Eye Movements Abdullah Moh. El-Menaisy, MD, FRCS Chief, Neuro-ophthalmology ophthalmology & Investigation Units, Dhahran Eye Specialist Hospital, Dhahran, Saudi Arabia Primary Motor Pathway
More informationVestibular Injury. Vestibular Disorders Association www.vestibular.org Page 1 of 5
PO BOX 13305 PORTLAND, OR 97213 FAX: (503) 229-8064 (800) 837-8428 INFO@VESTIBULAR.ORG WWW.VESTIBULAR.ORG Vestibular Injury Compensation, De-compensation, and Failure to Compensate By Thomas E. Boismier,
More informationTranslating the Biomechanics of Benign Paroxysmal Positional Vertigo Combined Sections Meeting Las Vegas, NV February 3-6, 2014
Translating the Biomechanics of Benign Paroxysmal Positional Vertigo to the Differential Diagnosis and Treatment Combined Sections Meeting Las Vegas, NV February 3-6, 2014 Richard Rabbitt, PhD, University
More informationBenign Paroxysmal Positioning Vertigo and Sleep: A Polysomnographic Study of Three Patients
Sleep Research Online 5(2): 53-58, 2003 http://www.sro.org/2003/monstad/53/ Printed in the USA. All rights reserved. 1096-214X 2003 WebSciences Benign Paroxysmal Positioning Vertigo and Sleep: A Polysomnographic
More informationTrouble Getting a Diagnosis?
PO BOX 13305 PORTLAND, OR 97213 FAX: (503) 229-8064 (800) 837-8428 INFO@VESTIBULAR.ORG WWW.VESTIBULAR.ORG By the Vestibular Disorders Association Trouble Getting a Diagnosis? Many people who suffer from
More informationVestibular Injury: Compensation, Decompensation, and Failure to Compensate
VESTIBULAR DISORDERS ASSOCIATION PO Box 13305 Portland, OR 97213 fax: (503) 229-8064 toll-free voice-mail: (800) 837-8428 info@vestibular.org http://www.vestibular.org/ VEDA Publication No. F-26 Vestibular
More informationDIZZINESS, VERTIGO, AND HEARING LOSS
C H A P T E R 18 DIZZINESS, VERTIGO, AND HEARING LOSS Kevin A. Kerber and Robert W. Baloh General Considerations 237 Historical Background 237 Epidemiology of Vertigo, Dizziness, and Hearing Loss Normal
More informationARE THE USE OF MEDICARE G CODES MAKING YOU SPIN?
1 2 3 4 5 6 7 8 ARE THE USE F MEDICARE G CDES MAKING YU SPIN? HERE ARE SME ANSWERS: VESTIBULAR REHABILITATIN SPECIAL INTEREST GRUP Functional Limitation Reporting Kenda Fuller, PT South Valley Physical
More informationA STUDY OF THE EFFECTS OF A VESTIBULAR REHABILITATION PROGRAM ON PATIENTS WITH PERIPHERAL VESTIBULAR DYSFUNCTIONS
The Indian Journal of Occupational Therapy : Vol. XXXVI : No. 1 (April - July 04) A STUDY OF THE EFFECTS OF A VESTIBULAR REHABILITATION PROGRAM ON PATIENTS WITH PERIPHERAL VESTIBULAR DYSFUNCTIONS * Pina
More informationSymptoms and Signs of Irritation of the Brachial Plexus in Whiplash Injuries
1 Symptoms and Signs of Irritation of the Brachial Plexus in Whiplash Injuries J Bone Joint Surg (Br) 2001 Mar;83(2):226-9 Ide M, Ide J, Yamaga M, Takagi K Department of Orthopaedic Surgery, Kumamoto University
More information2014 Neurologic Physical Therapy Professional Education Consortium Webinar Course Descriptions and Objectives
Descriptions and Neuroplasticity Health care providers are facing greater time restrictions to render services to the individual with neurological dysfunction. However, the scientific community has recognized
More informationHead Position and Impact Direction in Whiplash Injuries: Associations with MRI-Verified Lesions of Ligaments and Membranes in the Upper Cervical Spine
Head Position and Impact Direction in Whiplash Injuries: Associations with MRI-Verified Lesions of Ligaments and Membranes in the Upper Cervical Spine 1 Journal of Neurotrauma Volume 22, Number 11, November
More informationDizziness and balance problems
Dizziness and balance problems Dizziness and balance problems, Action on Hearing Loss Information, May 2011 1 Dizziness and balance problems This factsheet is part of our Ears and ear problems range. It
More informationHow To Diagnose Stroke In Acute Vestibular Syndrome
Danica Dummer, PT, DPT, University of Utah Abigail Reid, PT, DPT, Kessler Institute for Rehabilitation Online Journal Club-Article Review Article Citation Study Objective/Purpose (hypothesis) Study Design
More informationNonoperative Management of Herniated Cervical Intervertebral Disc With Radiculopathy. Spine Volume 21(16) August 15, 1996, pp 1877-1883
Nonoperative Management of Herniated Cervical Intervertebral Disc With Radiculopathy 1 Spine Volume 21(16) August 15, 1996, pp 1877-1883 Saal, Joel S. MD; Saal, Jeffrey A. MD; Yurth, Elizabeth F. MD FROM
More informationClinical guidance for MRI referral
MRI for cervical radiculopathy Referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of spine for a patient 16 years or older for suspected: cervical radiculopathy
More informationBEFORE THE ARKANSAS WORKERS COMPENSATION COMMISSION CLAIM NO. F107847 VINCENT E. BRADLEY, EMPLOYEE SINGLE SOURCE TRANSP. CO.
BEFORE THE ARKANSAS WORKERS COMPENSATION COMMISSION CLAIM NO. F107847 VINCENT E. BRADLEY, EMPLOYEE SINGLE SOURCE TRANSP. CO., EMPLOYER CLAIMANT RESPONDENT FIDELITY & GUARANTY INS. CO., CARRIER RESPONDENT
More informationVestibular Rehabilitation Therapy for the Dizzy Patient
Review Article 289 Vestibular Rehabilitation Therapy for the Dizzy Patient LH Tee, 1 Bphty, Mphty (Neurology), NWC Chee, 2 MBBS, FRCS (Edin & Glasg), FAMS (ORL) Abstract A customised vestibular rehabilitation
More information*A discrete, hypersensitive nodule within tight band of muscle or fascia that present with classic pattern of pain referral that does not follow
A patient presents with c/o cervical spine pain and chronic headaches that radiates across the top of his head. He also experiences frequent bouts of nausea, dizziness and indigestion. The patient also
More information1. Introduction 1.1 Definition and epidemiology of vertigo
1. Introduction Vertigo is one of the most common complaints in neurology and otology. Its prevalence increases with age but is often underestimated in elderly adults (1). Although most cases of vertigo
More informationSpine Vol. 30 No. 16; August 15, 2005, pp 1799-1807
A Randomized Controlled Trial of an Educational Intervention to Prevent the Chronic Pain of Whiplash Associated Disorders Following Rear-End Motor Vehicle Collisions 1 Spine Vol. 30 No. 16; August 15,
More informationCauses of Dizziness. Because of the many possible causes of dizziness, getting a correct diagnosis can be a long and frustrating experience.
PO BOX 13305 PORTLAND, OR 97213 FAX: (503) 229-8064 (800) 837-8428 INFO@VESTIBULAR.ORG WWW.VESTIBULAR.ORG Causes of Dizziness Dizziness, vertigo, and disequilibrium are common symptoms reported by adults
More informationNEURO-VESTIBULAR EXAMINATION
NEURO-VESTIBULAR EXAMINATION David E. Newman-Toker, MD, PhD The Johns Hopkins University School of Medicine Baltimore, MD Syllabus Contents 1. Head Impulse Test (pp 1-3) 2. VOR Cancellation Test (pp 4-6)
More informationVestibular Rehabilitation
5018 NE 15 TH AVE PORTLAND, OR 97211 FAX: (503) 229-8064 (800) 837-8428 INFO@VESTIBULAR.ORG VESTIBULAR.ORG Vestibular Rehabilitation An Effective, Evidence-Based Treatment By Lisa Farrell, PT, PhD, AT,C;
More informationVestibular Disorders: An Overview
5018 NE 15 TH AVE, OR 97211 FAX: (503) 229-8064 (800) 837-8428 INFO@VESTIBULAR.ORG VESTIBULAR.ORG Vestibular Disorders: An Overview By the Vestibular Disorders Association The vestibular system includes
More informationConcussions and Mild Head Injury. Post Concussion Syndrome. Whiplash Injuries
Concussions and Mild Head Injury Post Concussion Syndrome Whiplash Injuries Treat the cause, not just the symptoms NeuroSensory Center of Eastern Pennsylvania 250 Pierce Street, Suite 317 Kingston, PA
More informationPatient: A 65-year-old male who is a Medicare Part B beneficiary, whose testing was ordered by his internist
The following examples are to assist you with PQRS reporting. These examples were created in collaboration with the Academy of Doctors of Audiology and the American Speech-Language-Hearing Association
More informationCerebellum and Basal Ganglia
Cerebellum and Basal Ganglia 1 Contents Cerebellum and Basal Ganglia... 1 Introduction... 3 A brief review of cerebellar anatomy... 4 Basic Circuit... 4 Parallel and climbing fiber input has a very different
More informationBenign Paroxysmal Positional Vertigo: Management and Future Directions
UNIVERSITY OF SIENA PhD PROGRAM IN BIOMEDICINE AND IMMUNOLOGICAL SCIENCES CYCLE XXIV Benign Paroxysmal Positional Vertigo: Management and Future Directions Tutor: Chiar. mo Prof. Daniele Nuti PhD Student:
More informationPHYSICAL THERAPY Patient Education
FREE 2015 PHYSICAL THERAPY Patient Education ORTHOPEDICS BALANCE DIZZINESS Dr. Kimberly Fox, DPT Western Carolina Physical Therapy Dr. Kim Fox, PT, DPT, Advanced Vestibular Therapist Kim began her career
More informationVESTIBULAR REHAB ON THE REZ
VESTIBULAR REHAB ON THE REZ Lessons Learned in 4 Years of Starting Vestibular Rehab Services in Central Navajo Area LT Selena Bobula, DPT, NCS Senior Physical Therapist Coordinator, Navajo Area Neuro Special
More informationVestibular Rehabilitation Therapy (Rationale) Adaptation Guidelines. Substitution guidelines. Habituation exercise guidelines. Substitution guidelines
Vestibular Rehabilitation Therapy Outline: Rationale for the effect of exercises Framework for exercise prescription Exercise progression Preferred prescription patterns Case study General treatment guidelines
More informationVertigo: A Review of Common Peripheral and Central Vestibular Disorders
The Ochsner Journal 9:20 26, 2009 f Academic Division of Ochsner Clinic Foundation Vertigo: A Review of Common Peripheral and Central Vestibular Disorders Timothy L. Thompson, MD, Ronald Amedee, MD Department
More informationPathoanatomical Changes of the Brachial Plexus and of C5-C6 Following Whiplash-Type Injury: A Case Report
Pathoanatomical Changes of the Brachial Plexus and of C5-C6 Following Whiplash-Type Injury: A Case Report 1 Journal Of Whiplash & Related Disorders Vol. 1, No, 1, 2002 Gunilla Bring, Halldor Jonsson Jr.,
More information27. Dizziness and balance disorders
27. Dizziness and balance disorders Authors Torbjörn Ledin, MD, PhD, Associate Professor, Ear, Nose and Throat Clinic, Linköping University Hospital, and Division of Neuroscience Otorhinolaryngology, Department
More informationBalance problems and dizziness after brain injury: causes and treatment
Balance problems and dizziness after brain injury: causes and treatment Introduction The ability to maintain balance and orient ourselves to the outside world is vitally important. However, most people
More informationThe multitude of symptoms following a whiplash injury has given rise to much discussion because of the lack of objective radiological findings.
HELPFUL PERSONAL INJURY INFORMATION COURTESY OF RIVERVIEW CHIROPRACTIC FROM ABSTRACT: Dynamic kine magnetic resonance imaging in whiplash patients Pain Research and Management 2009 Nov-Dec 2009;Vol. 14,
More informationCervical Whiplash: Considerations in the Rehabilitation of Cervical Myofascial Injury. Canadian Family Physician
Cervical Whiplash: Considerations in the Rehabilitation of Cervical Myofascial Injury 1 Canadian Family Physician Volume 32, September 1986 Arthur Ameis, MD Dr. Ames practices physical medicine and rehabilitation,
More informationSoft-tissue injuries of the neck in automobile accidents: Factors influencing prognosis
Soft-tissue injuries of the neck in automobile accidents: Factors influencing prognosis 1 Mason Hohl, MD FROM ABSTRACT: Journal of Bone and Joint Surgery (American) December 1974;56(8):1675-1682 Five years
More informationDirections for construction used with permission from Pacific Science Center - Brain Power
Directions for construction used with permission from Pacific Science Center - Brain Power The Vestibular System The vestibular system within the inner ear detects both the position and motion of the head
More informationTYPE OF INJURY and CURRENT SABS Paraplegia/ Tetraplegia
Paraplegia/ Tetraplegia (a) paraplegia or quadriplegia; (a) paraplegia or tetraplegia that meets the following criteria i and ii, and either iii or iv: i. ii. iii i. The Insured Person is currently participating
More informationVestibular Neuritis and Labyrinthitis
PO BOX 13305 PORTLAND, OR 97213 FAX: (503) 229-8064 (800) 837-8428 INFO@VESTIBULAR.ORG WWW.VESTIBULAR.ORG Vestibular Neuritis and Labyrinthitis Infections of the Inner Ear By Charlotte L. Shupert, PhD
More informationCase Studies Updated 10.24.11
S O L U T I O N S Case Studies Updated 10.24.11 Hill DT Solutions Cervical Decompression Case Study An 18-year-old male involved in a motor vehicle accident in which his SUV was totaled suffering from
More information6/3/2011. High Prevalence and Incidence. Low back pain is 5 th most common reason for all physician office visits in the U.S.
High Prevalence and Incidence Prevalence 85% of Americans will experience low back pain at some time in their life. Incidence 5% annual Timothy C. Shen, M.D. Physical Medicine and Rehabilitation Sub-specialty
More informationTHE MANAGEMENT OF CONCUSSION IN AUSTRALIAN FOOTBALL
THE MANAGEMENT OF CONCUSSION IN AUSTRALIAN FOOTBALL AFL Research board AFL MEDICAL OFFICERS' ASSOCIATION THE MANAGEMENT OF CONCUSSION IN AUSTRALIAN FOOTBALL This document has been published by the AFL
More informationOutcomes After Rehabilitation for Adults With Balance Dysfunction
227 Outcomes After Rehabilitation for Adults With Balance Dysfunction Mary Beth Badke, PhD, PT, Terry A. Shea, BSc, PT, James A. Miedaner, MS, PT, Colin R. Grove, BSc, PT ABSTRACT. Badke MB, Shea TA, Miedaner
More informationCauses of Dizziness. By Vestibular Disorders Association, with edits by John King, PhD & Stacey Buckner, DPT. Vertigo
5018 NE 15 TH AVE PORTLAND, OR 97211 FAX: (503) 229-8064 (800) 837-8428 INFO@VESTIBULAR.ORG VESTIBULAR.ORG Causes of Dizziness By Vestibular Disorders Association, with edits by John King, PhD & Stacey
More informationFourth Nerve Palsy (a.k.a. Superior Oblique Palsy)
Hypertropia Hypertropia is a type of strabismus characterized by vertical misalignment of the eyes. Among the many causes of vertical strabismus, one of the most common is a fourth nerve palsy (also known
More informationVestibular Migraine May 2013
TITLE: Vestibular Migraine SOURCE: Grand Rounds Presentation, Department of Otolaryngology The University of Texas Medical Branch (UTMB Health) DATE: May 23, 2013 RESIDENT PHYSICIAN: Matthew Yantis, MD
More informationCase Series on Chronic Whiplash Related Neck Pain Treated with Intraarticular Zygapophysial Joint Regeneration Injection Therapy
Pain Physician 2007; 10:313-318 ISSN 1533-3159 Case Series Case Series on Chronic Whiplash Related Neck Pain Treated with Intraarticular Zygapophysial Joint Regeneration Injection Therapy R. Allen Hooper
More informationCollege of Health and Human Services Department of Physical Therapy
College of Health and Human Services Department of Physical Therapy Neurological Evaluation & Treatment II (PT244) Fall Semester 2009 COURSE CREDIT: 4 units: 2 hours lecture, 6 hours of lab per week CLASSROOM:
More informationMcKenzie Method. Physical Therapy Treatment for lower back pain by Amy Romano
McKenzie Method Physical Therapy Treatment for lower back pain by Amy Romano What is the McKenzie Method? The McKenzie method (also known as MDT = Mechanical Diagnosis and Therapy) is a comprehensive method
More informationCONGENITAL NYSTAGMUS WHEN TO RECORD HOW TO TREAT 2009
CONGENITAL NYSTAGMUS WHEN TO RECORD HOW TO TREAT 2009 LIONEL KOWAL Royal Victorian Eye and Ear Hospital Center for Eye Research Australia Melbourne, Australia TYPES OF CONGENITAL NYSTAGMUS cn cn: any type
More informationSymptoms of imbalance associated with cervical spine pathology
Washington University School of Medicine Digital Commons@Becker Independent Studies and Capstones Program in Audiology and Communication Sciences 2008 Symptoms of imbalance associated with cervical spine
More information