Spinning Beyond Basics: An Advanced Vestibular Rehabilitation Course

Instructor:

Janene M. Holmberg, PT, DPT, NCS received her BS degree in physical therapy from the University of Utah in 1987 and Doctor of Physical Therapy in 2009. Her doctoral project analyzed treatment outcomes/strategies in patients with refractory to care or resistive forms of BPPV. She has vast clinical experience having seen thousands of "dizzy" patients over the past 20 years. She became an ABPTS board certified Neurological Clinical Specialist in 1996, with Re-certification obtained in 2006. She is currently the Coordinator of Balance Rehabilitation at the Intermountain Hearing and Balance Center in Salt Lake City, Utah. Dr Holmberg serves as auxiliary faculty at Drs Herdman and Clendanial's annual Vestibular Competency course and the University of Utah physical therapy program and is the facial rehabilitation specialist for the Facial Disorders Center of the University of Utah School of Medicine. Her initial clinical work included an emphasis in stroke and brain injury rehabilitation with completion of her certification in NDT (Neuro Development Technique) in 1990. She completed clinical competency in Biofeedback training in 1991. Since 1991, she has passionately specialized in Vestibular Rehabilitation with a subspecialty (since 1996) in Facial Rehabilitation. Dr Holmberg is a member of the APTA Neurology Section's Vestibular Special Interest Group, the Vestibular Disorders Association, and the Acoustic Neuroma Society. She has lectured nationally with many leaders in the field of vestibular and balance rehabilitation, including numerous national conferences/ conventions. Since 1998, she has taught many courses in Vestibular Rehabilitation both introductory and advanced as well as courses in falls interventions in the elderly. Dr. Holmberg was the keynote speaker in the Utah Chapter APTA annual conference and in 2000 and was awarded Physical Therapist of the Year by the Utah Chapter APTA in 2001. In 2009, she was selected from applicants around the country to form a national core group of vestibular therapists to discuss and develop advanced vestibular rehabilitation concepts for the APTA neurology section. She was guest lecturer at the APTA's 2011 Combined Sections Meeting for the Vestibular Special Interest Group. Dr. Holmberg is currently collecting clinical outcome data on the effectiveness of vestibular and facial rehabilitation. Her current clinical practice consists of a broad scope of vestibular and neurological patients for which she draws on her extensive experience to help clinicians learn how to manage the complexities of the dizzy and unsteady patient.

Course summary: 

This two-day advanced course is designed for physical or occupational therapists, who have prior experience in vestibular rehabilitation and are seeking to refine their clinical evaluation and treatment skills beyond the basics. Therapists who are comfortable with their fundamental skills will find this course helpful at adding more treatment options to successfully treat the complex dizzy patient. Patient diagnoses discussed will include cervical dizziness, atypical BPPV, psychogenic, chronic subjective dizziness, migraine, acoustic neuroma, superior canal dehiscence, and Mal de Debarquement. Focus will be placed on case study applications with careful analysis of history, diagnostic clinical findings, and classification of dysfunctions to al[1]low optimal customized treatment protocols. Clinical skills to be taught will include fistula screening, cervicogenic screening, BPPV treatments beyond the posterior canal (anterior/ horizontal canals), acoustic neuroma management including exposure to facial rehabilitation techniques, migraine screening and treatments, and identification/management of psychological factors. All testing and treatment protocols presented will be evidence-based and clinically relevant to manage the dizzy patient more effectively. Lectures will intersperse the refining of clinical testing protocols with specific treatment strategies for a wide range of diagnoses. Instruction will be provided via lecture, videotapes, lab breakouts, detailed demonstrations, and case studies. Each participant will receive a comprehensive manual giving details of all recommended testing and treatment protocols.

Objectives: 

Upon completion of this course participants will be able to:

• Identify signs and symptoms that differentiate the diagnostic groups of BPPV, cervical dysfunction, psychogenic, Meniere’s disease and migraine.

• Perform appropriate examination procedures to distinguish between the diagnostic groups of BPPV, cervical, psychogenic, Meniere’s disease and migraine.

• Design customized exercise protocols for each of the diagnostic groups of BPPV, cervical, psychogenic, Meniere’s disease and migraine.

• Identify psychological problems that can affect the management of vestibular problems and learn how to modify treatment interventions, plans and goals.

• Recognize the role of Migraine as both primary (causing of distinct vertigious episodes) and secondary (traditional migraines leading to more persistent motion, intolerance) contributor to dizziness and it’s impact on rehabilitation.

• Develop an understanding of the important role of both the medical and rehabilitative aspects managing dizziness and when to refer to another provider.

• Identify a multitude of balance facilitation techniques both for motoric and sensory balance deficits with the dizzy patient.

• Develop skills related to the “fine art” of vestibular rehabilitation which is the accurate interpretation of eye motion as it relates to the patient’s clinical presentation.

• Develop improved management skills for patients with stable vestibular deficits such as status post acoustic neuroma surgery including an introduction to facial rehabilitation, expected outcomes, and treatment progressions.

• Identify the clinical presentation and learn clinical testing of patients with superior canal dehiscence (fistula) and current management.

• Recognize the clinical presentation of patients with Mal de Debarquement, current theories of pathophysiology and current recommended management strategies

Agenda:

DAY 1

7:30 8:00 Registration

 8:00 10:15 Introduction and Conceptual Framework

• Review of key components of vestibular anatomy and physiology important to the understanding of clinical testing and treatment

10:15 10:30 Break

10:30 12:00 Understanding Diagnostics and Vestibular Pathology

• Key clinical features of each of the common vestibular pathologies

12:00 12:45 Lunch (on your own)

12:45 2:00 Critical Clinical Examinations

• Reliability, validity and limitations of each specific test 2:15 3:45 Identifying and Treating Cervicogenic Dizziness (Lecture/Lab)

2:00 3:30 Identifying key history/clinical findings

• Key components to rehabilitation techniques

3:30 3:45 Break

3:45 5:45 Update on BPPV testing and treatment (Lecture)

 Question and Answers

DAY 2

8:00 9:30 BPPV Lecture/Lab (continued)

• Integrating/applying clinical findings and complex clinical cases

 9:30 9:45 Break

9:45 11:30 Identifying and Treating Fluctuating Vestibular Disorders

• Clinical presentation of fistula, both endolymphatic and superior canal dehiscence

11:30 12:15 Lunch (on your own)

12:15 1:15 Managing Post-Surgical and Stable Vestibular Lesions (Lecture/Lab)

• Introduction to fascial rehab

1:15 2:00 Identifying and Treatment of Central Pathologies

2:00 2:15 Break

2:15 2:30 Considerations for the “Rocking” Patient

• MdD treatment options and case study application

2:30 3:30 Identifying and Treating Psychological Disorders

factors)

3:30 3:45 Questions and Answers

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