Chapter 10: Examination and Treatment of Periphertermal Vestibular Disorders, Updated 5 Contact Hours
Expiration Date : June 3 , 2025 Learning outcomes 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 with vestibular dysfunction
Select appropriate examination measures based on patient report and presentation. Design appropriate treatment interventions based on interpretation of examination findings.
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.
INTRODUCTION
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.
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.
OVERVIEW OF VESTIBULAR DYSFUNCTION
to dizziness can develop a fear of falling, and subsequently reduce their mobility and participation in activities (Vellas et al., 1987), with as many as 56% of older adults restricting activities due to this fear (Howland et al., 1998). A systematic review of studies identifying the etiology of dizziness in the adult population revealed vestibulopathy, cardiovascular dysfunction, central nervous system (CNS) dysfunction or lesion, psychiatric, and other medical disorders (e.g., metabolic, polypharmacy) as the primary
Dizziness is a common complaint among adults aged 18 years and older (Kerber et al., 2017). The incidence of dizziness rises with advancing age, with 20% to 35% of persons over age 65 reporting problems with dizziness in the previous 12 months (Lin & Bhattacharyya, 2012; Tinetti et al., 2000). Symptoms of dizziness can have a catastrophic impact on wellness, often leading to unsteadiness with walking and increased incidences of falls and associated injuries. Persons experiencing difficulties with balance due
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