17.3: Vestibular Rehabilitation, Dizziness, Balance, and Associated Issues in Physical Therapy
NATA approved: #Q102-32

This independent study course series will provide in-depth coverage of the examination and intervention strategies involved in vestibular rehabilitation. The participant will learn the anatomical basis of the various systems that contribute to postural control and their interrelationships during normal and pathological function. Examination techniques will be reviewed that lead to differential diagnosis and result in the selection and implementation of the most effective evidence-based treatment strategies. Specific attention is given to assessment of the pediatric and geriatric patient populations.

Upon completion of this course, the course participant will be able to do the following:

1. Describe the embryogenic development of the vestibular system and associated anatomical structures involved in postural control.
2. Describe the impact of age-related changes on the visual, vestibular, and somatosensory systems with specific application to infants, children, and the elderly.
3. Recognize and appreciate the relationship between the vestibular, somatosensory, and visual systems in postural control.
4. Understand the contributions of vestibular input to the development of gaze stabilization, postural control, and motor development.
5. Identify signs and symptoms associated with peripheral or central vestibular dysfunction based upon past medical history and subjective reports.
6. Differentiate among other medical conditions that can mimic vestibular symptoms in the elderly and recognize key areas that are necessary for an accurate differential diagnosis.
7. Identify when it is appropriate to consult with or refer to a specialist for more comprehensive diagnostic testing or treatment.
8. Identify and utilize the appropriate tests and measures to examine the vestibular-ocular system, positional vertigo, and the vestibular spinal system as they impact static and dynamic postural control.
9. Identify the use and role of vestibular function tests (ccaloric testing, rotary chair testing, subjective visual vertical, subjective visual horizontal) as they relate to clinical diagnosis of vestibular pathology.
10. Implement a four-category diagnostic classification system for the differential diagnosis of patients complaining of dizziness.
11. Understand the pathophysiology, diagnostic criteria, and physical therapy management of cervicogenic dizziness.
12. Understand the pathophysiology of PPV and VBI.
13. Describe clinical assessment and methods to differentiate BPPV rom VBI and be able to formulate appropriate treatment strategies.
14. Describe the mechanisms underlying recovery of function following central and peripheral vestibular system lesions.
15. Based on examination results, identify appropriate interventions and treatments to facilitate recovery of function.
16. Integrate clinical data gathered during examination and develop a working physical therapy diagnosis and formulate appropriate interventions to facilitate recovery of function.
17. Use an evidence-based approach for choosing appropriate vestibular rehabilitation exercises.

• Vestibular Rehabilitation: Role of the Vestibular System and Associated Disorders
  Elizabeth Andrews, MSPT
• Vestibular Rehabilitation: Examination, Evaluation, and Treatment Intervention
  Mara Wernick Robinson, PT, MS, NCS
• Cervicogenic Dizziness and Differential Diagnosis of Dizziness in the Orthopaedic Physical Therapy Setting
  Peter A. Huijbregts, PT, MSc, MHSc, DPT, OCS, MTC, CSCS, FAAOMPT, FCAMT and Paul G. Vidal, PT, MHSc, DPT, OCS, MTC
• Vestibular Rehabilitation: Management of the Geriatric Patient
  Scott Cheatham, DPT, OCS, ATC, CSCS, NSCA, CPT
• Vestibular System Dysfunction in Children: Incidence, Evaluation, and Treatment
  Rose Marie Rine, PT, PhD
• Vertebral Artery or BPPV: Identification and Treatment of Benign Paroxysmal Positional Vertigo
  Diane M. Wrisley, PT, PhD, NCS

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