Experiences with overseas Vestibular Clinics

Anne McGann

Senior Clinician Physiotherapist

Churchill Fellow 2003

programme:

5 weeks in USA visiting: Johns Hopkins Medicine Emory University Pittsburgh University Medical Centre NYU RUSK Institute

2 weeks UK visiting Charing Cross Hospital National Hospital for Neurology &

Neurosurgery

vestibular clinics in usa

Diagnostic & Rehabilitation

co-existed Standard lab tests 1:1 customised therapy intervention Specialised clinics ENTs & Physios or Neurologists &

Physios Research occurring

johns hopkins medicinevestibular rehabilitation baltimore usa - dr richard clendaniel pt phd

Dept of Otolaryngology Vestibular Clinic ENTs Neurologists Physiotherapist

Diagnostic: Rotary Chair Calorics Auditory Testing Posturography

Rehabilitation: Physio assessed, treated & set up programme, HEP, Reviews +/- refer out to Physio Depts

emory university: dizziness & balance centre atlanta usadr susan herdman pt phd, dr ron tusa md phd

Balance & Dizziness Centre Neurologists X3 physios Lab assistants

Diagnostic: Calorics Rotary Chair VEMP SVV Posturography

Rehabilitation: Physio assessed, treated, set up programme, HEP, Reviews

pittsburgh university medical centre: balance centre - vestibular rehabilitation program pittsburgh usa - dr sue whitney pt phd

Neurology Clinic Neurologists

Diagnostic: Calorics, Rotary Chair Posturography

Rehabilitation: Balance Centre: Vestibular Rehabilitation Program X3 physios Physios assessed, treated, set up programme, HEP, Reviews

new york university medical centre: rusk institute: vestibular rehabilitation program new york usa -tara denham pt

Vestibular Rehabilitation Program X9 physios!

Diagnostic: Clinical diagnostic skills Posturography

Rehabilitation: Physios assess, treat, set up program, HEP,

Reviews

standard clinical assessment: Central signs

Smooth pursuit Saccadic eye movements

Peripheral signs: Hallpike-Dix Head Thrust Test

Balance measures: SOT Gait Functional Reach

Disability & Handicap: A fear of falling scale Dizziness Handicap Inventory

Vestibular clinics in uk

Diagnostic neuro-otology clinics – medical and lab tests Not “balance centres” Neurologists Standard lab tests +/- refer to vestibular rehab programmes Cawthorne Cooksey habituation approach Group sessions +/- 1:1 approach Research occurring Primary care approach

charing cross hospital: neuro-otology clinic charing cross uk - prof aldolfo bronstein md

Neuro-otology clinic Neurologists

Diagnostic: Calorics Rotary Chair

Rehabilitation: No direct link Drs treated BPPV

national hospital for neurology & neurosurgery: neuro-otology clinic queens square uk - prof linda luxon md

Neuro-otology Clinic Neurologists Audiologists

Diagnostic: Calorics Rotary chair Auditory tests

Rehabilitation: Part of physio dept workload Group Cawthorne & Cooksey exercise and Ed sessions Review in 6/52s for need for 1:1 therapy

evidence for vestibular rehabilitation (vr):

Customised VR vs general

conditioning exs & vestibular suppressant medications

(Horak et al1992)

Unsupervised Cawthorne-Cooksey exs vs supervised customised VR

(Szturm et al1994)

Customised habituation HEP vs control (Yardley et al 1998)