Chapter 6: Examination and Treatment of Periphertermal Vestibular Disorders, Updated 5 Contct Hours
Expiration Date : June 3 , 2025 Learning objectives After completing this course, the learner will be able to: Identify the anatomy and peripheral vestibular physiology, and pathways underlying gaze stabilization and postural control. Differentiate between the types of peripheral vestibular disorders. Course overview Vestibular disorders are common in the adult population, affecting a vast number of persons over 40 years of age, with increased prevalence of vestibular dysfunction occurring with advancing age. Persons diagnosed with vestibular disorders have a higher likelihood of experiencing problems with balance and dizziness, leading to reduced physical function and falls; subsequent early nursing home placement and mortality make early diagnosis and effective management essential. There is strong research evidence to support the efficacy of vestibular rehabilitation to reduce or eliminate the symptoms and sequelae associated with common vestibular disorders (Fujino et al., 1994; Hall et al., 2016; Lee & Kim, 2010). The vestibular system is a highly specialized sensory apparatus that integrates information regarding head movement and position relative to gravity with information from the visual and somatosensory systems to mediate upright posture, postural control, and gaze stabilization. Given the highly specialized nature of this system, physical therapy management of persons Implicit bias in healthcare Implicit bias significantly affects how healthcare professionals perceive and make treatment decisions, ultimately resulting in disparities in health outcomes. These biases, often unconscious and unintentional, can shape behavior and produce differences in medical care along various lines, including race, ethnicity, gender identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can manifest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient or make assumptions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can adversely impact health outcomes. Addressing
Select appropriate examination measures based on patient report and presentation. Design appropriate treatment interventions based on interpretation of examination findings.
with vestibular dysfunction requires additional education and training beyond what is offered in a typical entry-level physical therapy program curriculum. The vestibular system detects head motion to mediate gaze stabilization and postural control during head motion. Information from the vestibular end organs is integrated with sensory information from the visual and somatosensory systems in the central nervous system (CNS) to generate compensatory movements to maintain head and body postural stability and stabilize vision. Vestibular system impairments can result in a variety of symptoms, including vertigo and difficulties with gait and balance, which are the primary reasons patients with vestibular dysfunction seek care. Peripheral vestibular dysfunction is more common than centrally (CNS) mediated vestibular disorders, with the two most common peripheral vestibular disorders being benign paroxysmal positional vertigo (BPPV) and vestibular neuritis, each of which is effectively rehabilitated through a problem-oriented treatment approach. implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and awareness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Additionally, implementing policies and procedures prioritizing equitable treatment for all patients can play a pivotal role in reducing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treatment regardless of their background or characteristics.
INTRODUCTION
Detailed knowledge of the vestibular system is important for physical therapists to effectively manage balance and gait disturbances in patients with vestibular dysfunction. Differential assessment of the source of peripheral vestibular dysfunction depends on a comprehensive subjective account of symptom provocation and severity, as well as a targeted clinical examination. The key components of a clinical examination include oculomotor and vestibular function testing, measures of balance, gait, and fall risk. A review of musculoskeletal, neuromuscular, and cardiac systems must also be undertaken to differentiate causes of dizziness and balance and gait disturbances from a vestibular system etiology.
The purpose of this course is to educate the practicing physical therapist on the management of patients with peripheral vestibular disorders in order to expand their current practice skill set into the subspecialty of vestibular rehabilitation. This will be accomplished through knowledge of functional anatomy of the vestibular system and current methods of evidence-based examination and the process of differential assessment to determine effective treatment of common peripheral vestibular disorders, or when referral is appropriate. This intermediate-level course is targeted at practicing physical therapists who have experience managing patients with balance dysfunction and basic knowledge of standardized gait and balance measures.
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