Development of a physiotherapy-led balance clinic: the Aintree model

2014 ◽  
Vol 128 (11) ◽  
pp. 966-971 ◽  
Author(s):  
A V Kasbekar ◽  
N Mullin ◽  
C Morrow ◽  
A M Youssef ◽  
T Kay ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Benign Paroxysmal Positional Vertigo ◽  
Waiting Times ◽  
Clinic Visit ◽  
Positional Vertigo ◽  
One Stop ◽  
Set Up ◽  
High Level ◽  
Referral Letters ◽  
Paroxysmal Positional Vertigo

AbstractObjective:To create a ‘one-stop’ clinic in which assessment, diagnosis, treatment and therapies for most patients presenting with balance and dizziness disorders are delivered simultaneously.Methods:Patients triaged via referral letters were selected to attend the balance clinic, which is led by specialist balance physiotherapists. Patients were seen by an audiologist, and a ‘balance’ ENT consultant was available for joint consultations when required. Further details of the clinic set up are discussed.Results:Over an 18-month period, 200 new ‘dizzy’ patients attended the clinic. Benign paroxysmal positional vertigo and labyrinthitis were the commonest diagnoses. Fifty per cent of all patients were discharged after a single clinic visit. Questionnaires showed that patient satisfaction was high.Conclusion:The physiotherapy-led balance clinic has reduced patient waiting times to be seen, has a high level of patient satisfaction and is economically beneficial.

scholarly journals Diagnosis and treatment of benign paroxysmal positional vertigo in common clinical practice

2017 ◽  
Vol 89 (1) ◽  
pp. 57-61 ◽  
Author(s):  
N V Lebedeva ◽  
M V Zamergrad ◽  
V A Parfenov ◽  
L M Antonenko
Keyword(s):  
Cervical Spine ◽  
Benign Paroxysmal Positional Vertigo ◽  
Positional Vertigo ◽  
Spine Pathology ◽  
Medical Diagnostic ◽  
Set Up ◽  
Common Clinical Practice ◽  
One Year ◽  
Medical University ◽  
Paroxysmal Positional Vertigo

Aim. To analyze typical medical practice in managing patients with benign paroxysmal positional vertigo (BPPV). Subjects and methods. 33 patients (5 men and 28 women; mean age, 58 years) with BPPV who had been referred for consultation to the Medical Diagnostic Department, Clinic of Nervous Diseases, I.M. Sechenov First Moscow State Medical University, regarding for vertigo, were examined. Information about the disease before visiting the clinic, such as the duration of vertigo, its pattern, and triggers, previously established diagnoses, prescribed treatment and its efficacy, concomitant diseases, was analyzed. Results. BPPV was not timely diagnosed in 93.9% of cases. The cause of vertigo was most commonly mistakenly assumed to be cerebrovascular disease (66.6%) and cervical spine pathology (15.1%). During a primary examination, none of the patients underwent positional tests (otoneurological examination) that formed the basis for the diagnosis of BPPV. Alternatively, 90.3% of cases underwent instrumental examination: magnetic resonance imaging of the brain, X-ray of the cervical spine, and ultrasonic duplex scanning of the brachiocephalic arteries. Ineffective diagnosis led to the choice of nonoptimal treatment tactics: instead of therapeutic repositioning maneuvers (RM), the patients received therapy with drugs, such as various vasoactive agents (84.8%), nootropic and chondroprotective drugs (12%), or muscle relaxants (9.1%). After BPPV was detected, all patients underwent curative RM, which resulted in regression of the disease. One-year follow-up of the patients showed that the therapeutic effect of RM persisted. Conclusion. Lack of effective and timely diagnosis of BPPV reflects physicians’ poor awareness that this condition is the most common cause of vestibular vertigo. The role of vascular and cervicogenic factors in the development of vertigo is overestimated. Most patients with BPPV undergo unreasonable examinations and receive ineffective treatment. It is necessary to raise awareness of BPPV among of physicians and to set up specialized centers for the management of patients with dizziness.

Does vestibular habituation still have a place in the treatment of benign paroxysmal positional vertigo?

2000 ◽  
Vol 114 (7) ◽  
pp. 501-505 ◽  
Author(s):  
G. K. Banfield ◽  
C. Wood ◽  
J. Knight
Keyword(s):  
Benign Paroxysmal Positional Vertigo ◽  
Response To Treatment ◽  
Positional Vertigo ◽  
Spine Pathology ◽  
Before And After ◽  
Traditional Therapies ◽  
High Level ◽  
Term Response ◽  
Paroxysmal Positional Vertigo

Particle repositioning procedures such as the Epley manoeuvre have become popular in the management of benign paroxysmal positional vertigo (BPPV) at the expense of more traditional therapies such as vestibular habituation.We prospectively analysed the response of consecutive patients presenting with BPPV to treatment with vestibular habituation exercises using a symptom score sheet before and after treatment. This same patient group was then followed up, on average three years, eight months after discharge, to determine their long-term response to treatment.The results of the study demonstrated an excellent short-term response rate to treatment but a high level of recurrence after discharge. Most patients who experienced further symptoms following discharge were however self-reliant and were able to return to their habituation exercises without the need for further medical input.The aim in the management of these patients must be to provide long-term self reliance as well as shortterm cure and it may be that this has not yet been well demonstrated with the Epley manoeuvre. It must also be remembered that particle repositioning manoeuvres cannot be used in all patients for example those who suffer with cervical or thoracic spine pathology and that some will fail to respond at all.We believe that vestibular habituation retains a useful role in the treatment of BPPV.

scholarly journals A One-Stop Carpal Tunnel Clinic

2009 ◽  
Vol 91 (4) ◽  
pp. 301-304 ◽  
Author(s):  
MJ Reid ◽  
LA David ◽  
JE Nicholl
Keyword(s):  
Patient Satisfaction ◽  
Carpal Tunnel ◽  
Waiting Times ◽  
Cost Effective ◽  
Referral Letter ◽  
High Patient Satisfaction ◽  
One Stop ◽  
Tunnel Syndrome ◽  
Patient Consultation ◽  
Set Up

INTRODUCTION By December 2008, 90% of referrals requiring hospital admission will need to be seen and treated within the 18-week patient pathway. Previously, patients within our trust with suspected carpal tunnel syndrome had to wait 3 months to see a specialist in clinic and, once assessed, would have to wait up to a further 6 months for an open carpal tunnel decompression under local anaesthetic (OCTD/LA). We set up a one-stop clinic, where patients would have their out-patient consultation and surgery on the same day. We evaluated the clinic in order to assess whether it led to reduced waiting times whilst maintaining good clinical outcome and patient satisfaction. PATIENTS AND METHODS Patients were selected on the basis of the standard referral letter alone. Those selected were then assessed by a single surgeon in the clinic. The patients deemed appropriate underwent an OCTD/LA and were discharged the same day. Patients were followed up with a patient satisfaction and Boston questionnaire. RESULTS Forty-six patients underwent 63 OCTD/LA, waiting an average of 2.2 months (9 weeks) from referral. There was high patient satisfaction and improvement in symptoms following treatment in the clinic. CONCLUSIONS We believe a one-stop carpal tunnel clinic can be an efficient and cost-effective way of treating this common condition.

Clinical Implications of the Center of Balance for a Veteran with Traumatic Brain Injury

2015 ◽  
pp. 280-289
Keyword(s):  
Traumatic Brain Injury ◽  
Case Report ◽  
Brain Injury ◽  
Benign Paroxysmal Positional Vertigo ◽  
Medical Center ◽  
Treatment Plan ◽  
Successful Outcome ◽  
Model Case ◽  
Positional Vertigo ◽  
Paroxysmal Positional Vertigo

Background: It is known that traumatic brain injury (TBI), even of the mild variety, can cause diffuse multisystem neurological damage. Coordination of sensory input from the visual, vestibular and somatosensory pathways is important to obtain proper balance and stabilization in the visual environment. This coordination of systems is potentially disrupted in TBI leading to visual symptoms and complaints of dizziness and imbalance. The Center of Balance (COB) at the Northport Veterans Affairs Medical Center (VAMC) is an interprofessional clinic specifically designed for patients with such complaints. An evaluation entails examination by an optometrist, audiologist and physical therapist and is concluded with a comprehensive rehabilitative treatment plan. The clinical construct will be described and a case report will be presented to demonstrate this unique model. Case Report: A combat veteran with a history of a gunshot wound to the skull, blunt force head trauma and exposure to multiple explosions presented with complaints of difficulty reading and recent onset dizziness. After thorough evaluation in the COB, the patient was diagnosed with and treated for severe oculomotor dysfunction and benign paroxysmal positional vertigo. Conclusion: Vision therapy was able to provide a successful outcome via improvement of oculomotor efficiency and control. Physical therapy intervention was able to address the benign paroxysmal positional vertigo. The specific evaluation and management as pertains to the aforementioned diagnoses, as well as the importance of an interprofessional rehabilitative approach, will be outlined.

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