An Interdisciplinary Approach to Management of the Dizzy Patient

119 Pages·2014·2.91 MB·English

An Interdisciplinary Approach to
Management of the Dizzy Patient
Faith W. Akin, PhD
Courtney D. Hall, PhD
Mountain Home VA Medical Center
East Tennessee State University
Disclaimer
Dr. Hall received a stipend for travel expenses from
ASHA. Otherwise, she has no financial disclosures.
Dr. Akin had travel cost to a prior meeting
reimbursed by Otometrics. Otherwise, she has no
financial disclosures.

The views expressed here are those of the authors
and do not necessarily reflect the position or policy
of the Department of Veterans Affairs or the United
States government.
Prevalence and Incidence of Dizziness
• As many as 35% adults aged ≥ 40 years (69
million) in US have experienced some form of
vestibular dysfunction.
Agrawal et al., 2009
• 4% (8 million) adults report a chronic problem
with balance, and 1.1% (2.4 million) report a
chronic problem of dizziness alone.
NIDCD, 2010
• Dizziness or vertigo is a risk factor for falls in
older community dwelling adults

Deandra et al. 2010
Causes of Dizziness
• Vestibular disorders
• Cardiovascular disease
• Medications
• Nervous system disorders
• Orthostatic hypotension
• Osteoarthritis
• Vision disturbances
• Multiple sensory deficits
Obstacles to Care
• Providers lack training
• No standardized method for the evaluation of
dizziness across disciplines
• Multiple patient visits and unnecessary testing
for diagnosis
Newman-Toker et al., 2009; Polensek & Tusa, 2009
• No diagnosis for 20-40% of patients
Lawson et al., 1999
Interdisciplinary approach
Def: a group of health care professionals from
diverse fields who work in a coordinated
fashion toward a common goal for the patient.
Interdisciplinary Approach to Management of Dizziness
Otolaryngology/
Neurology
Medical diagnosis Psychology/
Psychiatry
Medical/surgical management
Referral for lab/imaging testing Mental health
services

Vestibular test

interpretation

Case history
Bedside tests

BPPV
Audiology Physical
QoL measures Therapy
Vestibular laboratory
assessment CDP Gait/balance
assessment/treatment
Gaze stability
exercises Vestibular rehabilitation
Agenda
• Role of Audiologist
– Scope of practice
– Overview of A&P of vestibular system (VOR)
– Assessment of vestibular function
• Role of Physical Therapist
– Scope of practice
– Assessment to identify specific impairments and
functional limitations
– Provide customized vestibular rehabilitation
• Discussion
Audiologist’s role in the dizzy patient
• Scope of practice
• Overview of A&P of vestibular system (VOR)
• Assessment of vestibular function
• Tests of SCC function
• Tests of otolith organ function
Audiologist Scope of Practice
• Assessment and interpretation of the vestibular
assessment

AAA

ASHA
• Treatment of individuals with vestibular
impairment

AAA