CLASSIFICATION SYSTEM FOR EVALUATION AND
TREATMENT OF DIZZINESS AND IMBALANCE
Julie Knoll, PT, NCS
Holiday Inn Riverside
2200 Burdick Expressway East
Minot, ND
April 9, 10, and 11, 2010
Course Description
The Classification System to be presented has been developed over a period of 15 years working with dizzy patients in a multidisciplinary setting with professionals in PT, Otology, Neurology, and Optometry. While teaching the common principles of evaluation and treatment of the patient with dizziness and imbalance from vestibular disorders, this course goes a step further in assisting the clinician in adequately classifying patients to determine which type of symptom group will respond best to particular interventions. This improves the outcome and reduces the duration of treatment by making the most effective treatment decisions, once the specific evaluation is made. This is an intermediate course covering dizziness of all types, imbalance, gaze instability, and positional vertigo. Specific intervention and exercise progression will be covered in the areas of habituation, balance training, gaze stability, and particle repositioning.
The third day of the course is optional to those who have participated in the first two days. It will focus on specific disorders and conditions including Menieres disease, migraine, psychologic issues, visual dysfunctions, disembarquement syndrome, and cervicogenic dizziness. Each will be discussed with pathology and specific treatment tools to use in those populations.
Course Objectives
Days 1 and 2
- Understand the anatomy and function of the balance system.
- Understand the conditions and symptoms of vestibular disorders.
- Learn the current evidence in the efficacy of vestibular rehabilitation.
- Learn to evaluate and treat the various symptoms of the patient with vestibular and balance problems.
- Classify the symptoms you evaluate to effectively design treatment programs and improve outcomes.
- Successfully evaluate and treat BPPV.
Day 3
- Identify fluctuating vestibular conditions and learn how they may affect the course of treatment and when referral to a specialist is necessary.
- Identify psychologic issues and conditions related to dizziness, learn how to educate and empower the patient, and understand how this may affect the time course and outcome of therapy.
- Learn to assess the visual system and recognize conditions that may require referral to a specialist.
- Evaluate and treat cervicogenic dizziness.
- Learn the features of disembarquement syndrome and the current best treatment methods for the patient who rocks after a cruise or train travel.
Course Schedule
Friday, April 9, 2010
12:30 p.m. - 1:00 p.m. Registration
1:00 p.m. - 3:00 p.m. Introduction with brief review of dynamic systems for balance and orientation, vestibular function and dysfunction
Efficacy of vestibular rehab
Introduction to Classification System: Defining categories by determining quality of symptoms and provoking factors
General principles to guide you with the dizzy patient
3:00 p.m. - 3:30 p.m. BREAK with Exhibitors
3:30 p.m. - 6:00 p.m. Evaluation and treatment of head motion provoked dizziness: pathology, tests and measures, and intervention for canal, otolith, and cervicogenic factors
6:00 p.m. - 7:00 p.m. DINNER with Exhibitors (provided)
7:00 p.m. - 8:00 p.m. Evaluation and treatment of dizziness at rest
Evaluation and treatment of visual motion provoked dizziness: pathology, tests and
measures, and intervention for visual motion sensitivity
Saturday, April 10, 2010
9:00 a.m. - 12:00 noon Evaluation and treatment of gaze instability: pathology, tests and measures, and intervention for VOR disruption
Evaluation and treatment of imbalance: pathology, tests and measures and intervention for visual dependence, somatosensory dependence, decreased head righting, decreased strategy selection and musculoskeletal factors
12:00 noon - 1:00 p.m. LUNCH (provided)
1:00 p.m. - 2:00 p.m. Putting it all together on the first patient visit: demonstration of initial evaluation and exercise
prescription and progression
2:00 p.m. - 4:00 p.m. BPPV: pathology, evaluation and treatment of posterior, anterior, and horizontal canals with
CRP, liberatory, roll, and appiani maneuvers
Sunday, April 11, 2010
9:00 a.m. - 12:00 noon Review classification categories, question and answer session
Fluctuating conditions: Endolymphatic Hydrops, Menieres Disease, and migraine
Psychological factors in dizziness
Psychogenic dizziness
Visual disturbances that contribute to dizziness
12:00 noon - 1:00 p.m. LUNCH (provided)
1:00 p.m. - 3:00 p.m. Cervicogenic dizziness: neck torsion testing, cranial base testing, cervical kinesthetic testing,
muscle activation patterns
Interventions for cervicogenic dizziness
3:00 p.m. - 4:00 p.m. Mal de Debarquement Syndrome
4:00 p.m. - 4:30 p.m. Questions and Wrap-up
Course Faculty
Julie Knoll, PT, NCS
Julie has been practicing since 1992, after graduating from the University of North Dakota Physical Therapy program. She began clinical practice in Denver at St. Joseph Hospital and went into private practice in 1995.
Julie is co-owner of South Valley Physical Therapy, an outpatient neurologic practice in Centennial, Colorado, and has specialized in the treatment of dizziness and balance disorders, multiple sclerosis, movement disorders, including parkinsons and dystonia, brain injury, and facial disorders. She has worked closely with the Colorado Neurologic Institutes Deep Brain Stimulator Program and developed the Physical Therapy examination protocol for patients pre- and post-DBS placement. She was also a member of the interdisciplinary team of the Rocky Mountain Dizziness and Balance Center for 15 years and continues to participate in grand rounds with this group in Denver.
Her special interest is in neuro-plasticity and using moderate exercise as medicine for chronic neurologic conditions. She is a board certified neurologic clinical specialist since 1997, and is both NDT and Vestibular certified. Julie is a member of the APTA Neurologic Sections Vestibular Special Interest Group and actively reviews the literature in this area.
Julie teaches seminars across the western U.S. on vestibular rehabilitation and has been an invited lecturer at over 30 conferences. She has been awarded the Outstanding Physical Therapist of the Year and the Bob Doctor Service Award by the Colorado American Physical Therapy Association.
There is a block of rooms reserved for NDPTA at the Holiday Inn-Riverside, 2200 Burdick Expressway East in Minot. Phone: 1-800-468-9968. Room rate is $71 per night.
