Vestibular Rehab: A Physical Therapist's Perspective

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.