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  • 1. Experiences with overseas Vestibular Clinics Anne McGann Senior Clinician Physiotherapist Churchill Fellow 2003
  • 2. 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
  • 3. 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
  • 4. johns hopkins medicine vestibular 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 
  • 5. emory university: dizziness & balance centre atlanta usa dr 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,
  • 6. 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
  • 7. 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
  • 8. 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 
  • 9. 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
  • 10. 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
  • 11. 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
  • 12. 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)