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PT on the Run

Can You Describe Your Dizziness?

Published April 10, 2014 4:12 PM by Michael Kelley

We've all seen it before... a patient comes into your hospital or clinic complaining of the dreaded "dizziness." It's been said that dizziness is one of the most difficult subjective symptoms to diagnose because it can be caused by such a wide variety of physiologic and even psychological issues. I personally have seen patients with a primary complaint of dizziness who have had cardiac issues, neurologic issues, psychological issues, musculoskeletal issues, renal issues, and the list goes on!

A few weeks ago, I attended a CE course on another potential cause of dizziness... the vestibular system. Now I remember learning about the vestibular system in PT school, but we practiced our Dix-Hallpike tests and Epley maneuvers on our classmates, who clearly did not have vestibular disorders. So needless to say, when I started my job, I didn't feel comfortable treating actual patients. I had never worked with a vestibular patient on any of my clinical rotations in school, so they were sort of a foreign population to me. The course I took was well organized and thorough. I can honestly say I enjoyed the class, the presenters, and re-learning the vestibular system as well.

Since the class, I've had the opportunity to work with a couple of vestibular patients who have been admitted to the hospital with "dizziness." While my diagnostic skills need some improvement, I feel pretty comfortable performing the various positioning tests and treatment positions as well. We are fortunate to have a couple of outpatient PTs who have been working with vestibular patients more regularly and for several years. They are great about offering some mentorship, even coming to see inpatients who have vestibular issues and helping us inpatient PTs work through some of the more complicated patients.

Overall, I find the vestibular system pretty intriguing. It seems to me it's a very specialized system that has very specific deficits. And with the various repositioning techniques we have at our disposal, we can offer a unique opportunity for a potentially "quick fix" for our patients. I'm looking forward to growing in this area and hopefully becoming a little more proficient in my examination and treatment of patients in this population.

Does anyone else work with vestibular patients? Any thoughts or ideas on how I might improve my examination skills?

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We encounter this daily in our fall prevention clinic. Patients often say say they are "dizzy" when they mean lightheaded. I ask them, "When you say 'dizzy' do you feel lightheaded or does the room spin 'round?" Very often this works. I remember the first time I did an Epley on a real patient, it was very intimidating, particularly because it was a manager therapist! Worked out very well and we had support for adding vestibular rehab into our clinic!

Practice, practice, practice is how you become more comfortable with the procedures. The history you take is what will make you the better diagnostician though.

Have you read this article? Yes, it is old, but very enlightening: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC505972/?page=1

Dean Metz April 13, 2014 4:16 PM

I'm a neuro therapist and I dislike vestibular patients.  Its hard to get them to describe their symptoms in a way others can understand.  Try asking is the room spinning around you or are you spinning in the room.  That helps clarify the dizziness.  Many of the patients we see are BVVP which is relatively easy to treat.  The first time I did I resolved the dizziness but the patient threw up on me.  Good luck.

Toni April 11, 2014 7:43 PM

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