During the COVID-19 pandemic, physical therapists transitioned to provide telehealth in the United States. We sought to determine the experiences of physical therapists delivering telerehabilitation for vestibular disorders including barriers, preferences, and concerns. A survey was created using the results of a focus group and previously published studies. The survey was distributed across social media sites and through email- the link was sent to the orthopedic, neurologic, and geriatric academies of the American Physical Therapy Association list serves. The email was also shared with each of the 50 state chapters of the American Physical Therapy Association. The survey was broken down into five sections: demographic information, physical therapists' general impressions of telehealth, physical therapists' comfort level treating various vestibular diagnoses, and common barriers physical therapists experienced during telehealth sessions. There were 159 completed surveys. More than 80% of physical therapists surveyed agreed that telehealth was an effective platform for vestibular physical therapy. When asked whether physical therapists felt the patient had similar health outcomes with telehealth versus clinic care 68% of physical therapists agreed. For the physical therapists who treated posterior or horizontal canal benign paroxysmal positional vertigo via telehealth, more than 50% were comfortable treating these conditions via telehealth. In analyzing common peripheral vestibular diagnoses treated via telehealth including bilateral vestibular loss, Meniere's disease, and vestibular neuritis more than 75% of the physical therapists reported comfort treating these diagnoses. Similarly, more than 75% of physical therapists who treated central vestibular diagnoses- including mild traumatic brain injury and vestibular migraine- via telehealth reported being comfortable treating these diagnoses. Physical therapists reported several barriers to tele healthcare ranging from concerns about testing balance with no caregiver present (94%) to challenges with providing a written home exercise program (33%). Physical therapists report that telehealth is a viable mechanism for providing rehabilitation for persons with balance and vestibular disorders. For common diagnoses, most physical therapists were comfortable treating vestibular disorders via telehealth. While barriers remain including maintaining patient safety and being able to complete a thorough vestibular exam, telehealth for vestibular physical therapy services holds promise for the delivery of virtual care.
ObjectiveTo assess the prevalence of benign paroxysmal positional vertigo (BPPV) in traumatic brain injury population.Study DesignIn this cross-sectional design, each subject completed screening for BPPV, which included subjective questioning and positional testing. Subjects were asked if they experienced dizziness with bed mobility. All were tested with the Dix-Hallpike and the roll test to determine if nystagmus consistent with BPPV was present.SettingBrain injury inpatient rehabilitation unit.ParticipantsSubjects admitted to the rehabilitation unit during a 6-month time frame who had a traumatic mechanism of brain injury or experienced a fall resulting from a neurologic event.InterventionsDiagnostic interventions included the Dix-Hallpike and roll tests.Main MeasuresThe primary outcomes of this study were the prevalence of BPPV and symptom reports.ResultsSeventy-six subjects met the inclusion criteria. Three subjects were transferred to acute care before screening for BPPV could be completed. Of the 73 subjects who completed the screening process, 42 (58%) tested positive for BPPV, of which only 7 (10%) reported subjective symptoms of dizziness and/or vertigo. χ2 Analysis of the two screening methods demonstrated a statistically significant difference in the positivity rate between tests (χ21 = 5.715, p = 0.017, Cohen's W = 0.279). If subjects responded yes to both screening questions, they were significantly more likely to test positive for BPPV with a moderate effect size of 0.279.ConclusionThere was a high prevalence of BPPV within an inpatient rehabilitation facility in subjects with traumatic brain injury, with a small percentage of patients reporting dizziness with subjective questioning.
BACKGROUND: The video head impulse test (vHIT) is a common assessment of semicircular canal function during high-speed impulses. Reliability of the vHIT for assessing vertical semicircular canals is uncertain. Vertical head impulses require a complex head movement, making it difficult to isolate a single semicircular canal and interpret resulting eye rotations. OBJECTIVE: The purpose of this study was to provide descriptive head kinematics and vestibular stimuli during vertical plane impulses to ultimately improve impulse delivery and interpretation of vHIT results for vertical semicircular canals. METHODS: Six participants received right anterior (RA) and left posterior (LP) semicircular canal impulses. Linear displacements, rotational displacements, and rotational velocities of the head were measured. Peak velocities in semicircular canal planes and peak-to-peak gravitoinertial accelerations at the otolith organs were derived from head kinematics. RESULTS: The largest rotational velocities occurred in the target semicircular canal plane, with non-negligible velocities occurring in non-target planes. Larger vertical displacements and accelerations occurred on the right side of the head compared to the left for RA and LP impulses. CONCLUSIONS: These results provide a foundation for designing protocols to optimize stimulation applied to a singular vertical semicircular canal and for interpreting results from the vHIT for vertical semicircular canals.
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