BackTable / ENT / Podcast / Episode #36
Vestibular Rehab: A Physical Therapist's Perspective
with Matthew Johnston, PT
We talk with Vestibular Therapist Matthew Johnston about the workup of dizziness and setting up patients for success with Vestibular Rehab.
BackTable, LLC (Producer). (2021, November 9). Ep. 36 – Vestibular Rehab: A Physical Therapist's Perspective [Audio podcast]. Retrieved from https://www.backtable.com
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Matthew Johnston, PT
Matthew Johnston, PT is the clinic director at Excel Physical Therapy and Fitness in Philadelphia, Pennsylvania.
Dr. Gopi Shah
Dr. Gopi Shah is a practicing ENT at UT Southwestern Medical Center in Dallas, TX.
Dr. Ashley Agan
Dr. Ashley Agan is a practicing ENT and assistant professor at UT Southwestern Medical Center in Dallas, TX.
In this episode, physical therapist Matthew Johnston joins Dr. Gopi Shah and Dr. Ashley Agan to discuss the process of vestibular evaluation, rehabilitation, and long-term care.
First, Matthew speaks about the importance of obtaining a thorough past medical history to identify the patient’s onset, duration, and aggravators/alleviators of dizziness. These responses help him set up a physical examination, which includes the Vestibulo-Ocular (VOR) Cancellation test, the Clinical Test of Sensory Interaction in Balance (CTSIB), and the Dix-Hallpike test. All of these diagnostic tools help him evaluate the patient’s vestibulo-ocular reflex and check for nystagmus.
Matthew distinguishes between Benign Paroxysmal Positional Vertigo (BPPV) and other conditions of vestibular hypofunction such as Meniere’s Disease and vestibular neuronitis. While the former is curable, the latter conditions are more chronic and complex, so it is important to manage patient expectations and emphasize symptom alleviation. Overall, Matthew believes that identifying the affected ear canal and specifically matching the treatment to the canal is the most efficient way to treat patients.
We close by talking about ways to improve the patient’s physical therapy experience, through prescribed anti-nausea medications, maintenance exercises done in the home, and partnership between ENTs and physical therapists.
Excel Physical Therapy: https://excelphysicaltherapy.com/
[Matthew Johnston PT]
More often than not, we send patients away because their blood pressure is inappropriate for us to see. It's sending them back to their primary care for further management. Sometimes in rare occasions, it's like, you need to go to the hospital. We call the primary care and they say, no, send them, send them right over to the emergency department.
That's probably the biggest thing that we kind of stop session for. And then other things, we'll see some vertical eye movements that might be concerning for us. We might see some things that like, everything is negative. We've done maybe some initial treatment and still quite aren't sure it's vestibular oriented.
So that might be something that might warrant at least further imaging or further workup might not be “a red flag,” but something that we need a little more collaboration with. But by and large, at least in my experience with the patients, I see some sort of cardiovascular suspected stroke or blood pressure issue.
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