Vestibular Videos and Multisensory Integration Impairment Case Study

 

Author: Ashlyn Warren, SPT

Primary Advisor: Karen McCulloch PT, PhD, MS, FAPTA, FACSM, NCS(E)

Committee Members: Vicki Mercer, PT, PhD, Jeremy Bradford, PT, DPT, OCS, and Blair Bergquist, PT, DPT

Background:

Going into my second clinical rotation, I had little experience with evaluating and treating patients with vestibular disorders. Throughout my clinical rotation, I saw many patients who presented with a primary complaint of “dizziness” or “imbalance.” I quickly realized the breadth of pathologies and mechanisms that can contribute to these symptoms and found it fascinating. I also came to realize how much these symptoms affect our patient’s quality of life, making everyday tasks such as driving and walking difficult. Throughout my rotation, the importance of physical therapy in treating these patients and allowing them to experience greater quality of life became clear. With the help of my clinical instructors, I was able to develop my clinical skills and passion for working with patients with vestibular disorders. My instructors played a crucial role in developing my critical thinking skills when working with these patients and coming up with creative interventions catered to the patient’s individual needs. This clinical experience inspired me to complete my capstone project on learning more about the evaluation and treatment of patients who present with dizziness and imbalance.

Statement of Need:

Many clinicians do not feel comfortable diagnosing and treating vestibular disorders and differentiating the multitude of pathologies and mechanisms that contribute to complaints of dizziness and imbalance. This is an essential skill as dizziness is commonly experienced in older adults and the presence of dizziness is associated with falls and decreased quality of life. Furthermore, the experience of dizziness is prevalent across practice settings and patient populations. By conducting a thorough examination of the dizzy patient, we can appropriately treat vestibular disorders and identify serious neurological conditions that warrant referral to a neurologist for further testing.

Although we learn about vestibular dysfunction in our PHYT 784 course, one thing I recognized while on my clinical rotations and in speaking to fellow classmates was the breadth of information learned in such a short period of time. Many of us are visual learners and access to video resources can help supplement the information in lectures. Therefore, one of my main focuses of this capstone was to improve access to video resources that can be referred to post-graduation by embedding videos from F.A. Davis into the lecture materials for the PHYT 784 course. The other overarching goal of this project was to incorporate a case study on multisensory integration impairments in older adults. This case study is necessary as many older adults present with non-specific dizziness and imbalance it can be hard to pinpoint a specific cause of their complaints. This case study looks at an evidence-based approach to evaluating and treating an older adult patient with impairments in multisensory integration.

Purpose:

The purpose of this capstone project was two-fold: to present a case study focused on multisensory dizziness in older adults to supplement the content taught in PHYT 784 and to improve access to video resources and information for students to refer to during clinicals and future clinical practice. The materials will help supplement the vestibular lectures, which are taught over two days during the PHYT 784 course at UNC.

Products:

My products for this capstone project consist of the following:

(1) Multisensory integration impairment case study which will be used to supplement the information in the vestibular lectures for PHYT 784.

Multisensory Older Adult Case Study

(2) Incorporation of Herdman videos from the F.A. Davis textbook demonstrating clinical skills for vestibular evaluation and treatment.

https://docs.google.com/presentation/d/1rlEfUEsSTJwbJYyJbiG1J8q–gmCe11X00bDEs5EctM/edit?usp=sharing

(3) An updated resource guide with valuable links to more information on vestibular rehabilitation.

Updated_Videoclips for vestibular class

Self-Reflection:

Overall, I learned so much from this capstone project and feel that the process has been beneficial to my growth and preparation for becoming a clinician. I have honed my skills of incorporating clinical experiences and literature review to ensure that my treatment plan is sound and backed by current evidence. I have also gained so much from utilizing feedback from my committee and primary advisor to improve project materials. This experience of asking for feedback from more experienced clinicians has been invaluable and will translate well in seeking out mentors to improve future clinical practice. This project has also helped me develop my skills of creating materials aimed at educating peers and colleagues. It is my hope that these materials will supplement the vestibular lectures in PHYT 784 and help future cohorts improve their clinical competency with treating vestibular disorders and identifying multisensory integration impairments in older adults. Lastly, this project has broadened my knowledge and understanding of vestibular disorders. I am interested in working in neurology after graduation and believe this project has been integral in furthering my clinical skills when working with patients who complain of dizziness and imbalance, a common complaint in this setting.

Evaluation:

To evaluate my project, I utilized frequent self-assessment and revision in addition to integrating the valuable inputs provided by my primary advisor and committee members. Through reflection and feedback, I was able to make several rounds of revisions in order to develop the final product.

I have also developed this quick 5-question evaluation tool that will help to give me insight into how useful these materials are for clinical practice and what could be improved. If you could take a few minutes to review the PowerPoints and evaluate the effectiveness of materials it would be much appreciated! The link can be found below:

https://forms.gle/9XmGUUJmcc9G24ieA

Acknowledgements:

Dr. Karen McCulloch PT, PhD, MS, FAPTA, FACSM, NCS(E): Thank you for the time and effort you have dedicated to serving as my primary advisor on this project. I have learned so much from you through my education at UNC and have appreciated your mentorship throughout the development of my capstone. Your clinical and educational experiences have been invaluable to the development of materials for this project and my preparation as a future PT!

Dr. Vicki Mercer, PT, PhD: Thank you for taking the time to serve as one of my committee members on this capstone project. Your contributions to my education and feedback on this project have been crucial in the development of my capstone and clinical skills. I greatly appreciate the effort you put into helping focus my efforts on this project, thoroughly reviewing the materials, and providing feedback to refine the final capstone deliverables!

Dr. Jeremy Bradford, PT, DPT, OCS: Thank you for donating your time to serve as a committee member on this capstone project and serving as such a valuable clinical instructor. I have learned so much from your clinical expertise and ability to treat such a wide variety of patient populations in physical therapy. Your contributions to this project and to my clinical knowledge have been paramount to my success and preparation for practice!

Dr. Blair Bergquist, PT, DPT: Thank you for taking time out of your busy schedule to serve as a committee member on this capstone project and inspiring my passion for treating vestibular and neurological disorders. The clinical experiences, input, and resources you have provided in the development of this capstone have been so valuable. You have helped to shape the image of how I would like to practice as a physical therapist and I admire you and Jeremy’s dedication to serving as such excellent clinical instructors!

References Utilized in Case Study:

1. Herdman PT PhD FAPTA SJ, Clendaniel PT PhD R. Vestibular Rehabilitation (Contemporary Perspectives in Rehabilitation). 4th ed. F.A. Davis Company; 2014:544.
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8. Berg balance scale. Shirley Ryan AbilityLab. https://www.sralab.org/rehabilitation-measures/berg-balance-scale. Published 2020. Accessed April 1, 2023.
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19. Allison LK, Kiemel T, Jeka JJ. Sensory-challenge balance exercises improve multisensory reweighting in fall-prone older adults. Journal of Neurologic Physical Therapy. 2018;42(2):84-93. doi:10.1097/npt.0000000000000214
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