I love this exs..very functional task oriented dynamic postural stability exs. Thank you ! I'm so proud to be part of vestibular rehab

Vestibular Practice in the Emergency Department Course: theeddpt.com/vestibular-practice-in-the-emergency-department/

Great ideas!

I have a question 😊 Would you be able to do a VOR- cancellation test with the Goggles, if you turn on the lights and ask the patient to focus on the light while rotation the head from side to side and the analyze the eye movements afterwards? Hope it make sense 😊

I have meniere's it's horrible. I finally got a good doctor that helped me get it under control. I was having 3 attacks a week each over 12 hours. I just hit 32 days no attacks. The worst is the anxiety of am I feeling a vertigo attack coming on or am I ok.

Some confusion in the nomenclature used here. Short arm PSC-BPPV in this video is referred to as the non-ampullary canalolithiasis variant of the common crux. But in some papers this is referred to as otoliths trapped onto the utricular side of the PSC cupula. This is also said to sometimes generate downbeat nystagmus when head is more extended in the Hallpike, otherwise often not visible. Treatment through repeated ipsilesional Dix Hallpike--Sit ups seems to be succesful in case of canalolithasis here. For the common crux problem I've found success with the Demi-Semont which isn't mentioned here in the video And anecdotally, I've personally encountered lots of these odd PSC variants and just a few true AC-BPPV. In those true AC cases the patients had really strong paroxysmal downbeat nystagmus in the Deep Head Hang and I've never seen such a response in the other PSC-BPPV variants. So if I see this downbeat positional nystagmus that I suspect being peripheral without robust response in the Deep Head Hang, I always default treating for PSC, manuevers specific to common crux issue or the utricular side of the cupula. Haven't found success with the Yacovino in those cases

I was hoping for inner ear migraines but the diagnosis is meniere's

And on the JPE it’s worth noting if one (or both sides) are undershooting or overshooting consistently.

Awsome!

what is treatment for anterior-canal bppv?

When they will be on the market?

Access Full Journal Club Recording: kzbin.infottLtYdANoZc

This is so disheartening that she keeps laughing and I am over here suffering. 😢

My massage therapist is incredible. Receives all symptoms but they return. I'm currently doing physio too

😊

This is my own experience and not what I was foretold, my Meniere disease was very complicated with high pitch ear ringing, Dizziness and Imbalance but I was able to conquer this disease with a medicine from Dr Madida Sam on KZbin for only 4 weeks of using their treatment...I recommend this herbal center..

Thank you for this podcast. I was diagnosed with VM, age late 60s, yet I do not have a history of migraine. So I was surprised with the diagnosis, yet most other symptoms seem to fit. Also, my mother had it.

Informative, thanks to all of you for your efforts.

Please find a cure🙏🏻🤦🏻‍♀️😵‍💫❤️

What has Dr. Sharon seen in studies that actually does help with vestibular migraine besides CGRP which I’m actually doing now..Ajovy specifically. I’m also doing Botox.. what is his opinion on dropping the Botox and sticking to just ajovy? What does he recommend in his practice?

No offence but that’s why it’s called an idiopathic disease cause no one has an idea what they’re talking about. Something doctors don’t know what it is they say Ménière’s 🤷🏻‍♂️

For my other health problems I've been told to eat extra salt and to add salt on everything. Oh man this is going to be a nightmare to figure out. lol

I suffered for two years with this. 15 years if I’m looking back at things. Two years before it surfaced to the point I had a break down . Isolated. Etc. I told my optometrist I had vertigo and asked if I was related possibly to my eyes. He said not likely. Told me I had astigmatism and sent me off with a new script. Those glasses worsened my problem which I had such a hard time describing. Went back to him and he dug in. I have vertical misalignment. Sent me to see Tina Rutar who confirmed it. Two weeks into my prisms and after seeing her for a second time, I am still dizzy. Not nearly as bad as before. Headaches are gone. Eye fatigue is still present. My anxiety is off the charts still. My pcp recommended L-theanine for the anxiety. It has been a game changer. Until you get me into a store with bright lighting and packed full of people. I would love to go vision therapy. Our insurance won’t cover any of it. It’s way too expensive. So instead I feel like these glasses which I hate wearing, are a crutch. I want to fix this. Not make it worse. I guess my problem isn’t bad enough for surgery. Poor quality of life doesn’t qualify me. It’s so tragic. The medical system we have to endure is just so broken. My question is this. Why not check for this in all exams? Especially if someone complains of a definite change in vision. Why do we have to go through all this to get to this test? Why do some eye doctors not know anything about this? People are suffering with mental health issues because of this. I thought mental health was the topic of the day in the country? Unless you are truly suffering I guess.

Just an update: Johns Hopkins will have another awesome hybrid vestibular course in 2024. Online course will open Mar 1 and close Nov 30 in 2024. In person competency instruction and testing is FRIDAY Sept 13 afternoon to Sunday Sept 15 afternoon at Johns Hopkins. Follow @hopkinsrehabtherapy on Instagram or watch medicine.learnmore.jhu.edu/ for updates - they will post the ability to register soon!

Your guests were very professional and informative. Your uncomfortable giggling is just weird.

Un test vemps diminué d une oreille, test otolitique. Ca peut venir des cervicales ?

apologize but I write with the translator. Which doctor or center in Italy is able to diagnose it. I have dizziness, left artery stenosis when I rotate my neck to the right, blurred vision and other symptoms. I have been around for 12 years but the doctors cannot understand my problem. The cause is a head injury.

Thank you all for the great information. It's helpful to know more and to be able to comprehend the intricate complexities of all the issues.

Great Chanel, I’m able to come back and review some of these older videos that I missed.

Thank you for keeping us updated on all things vestibular migraine, it is definitely the most common type of patient I see in our outpatient clinic and BPPV has now dropped to no 2.

Great and deep scientific talk. Thanks!

I see so many migraineurs that come in and present with either DB vertical nystagmus, dizziness is mild and resolves in seconds and they have persistent nystagmus with VFG fixation. Also, there is no crescendo and descendant of symptoms. The nystagmus is very low amplitude.

Loves these literatura review series, thank you for keeping vestibular therapist on our toes!

Is Videonystagmography a test for diagnosing pppd?

How do you measure the degrees/second for the treatment if you do not have the higher tech equipment? Is there a way to convert this for speed that they can use at home?

OBRIGADO TKS

Thanks! This was a great talk and an area that gets overlooked or under addressed. I am glad to put a name to the magnocellular issues I have seen with patients but didn’t know what to call it. I find backwards walking (on FGA) frequently will flags in people displaying this issue.

Thank you Helena and Dr. Bliss this was so informative. Excellent topic

That is awesome, so helpful for visualizing what's going on during maneuvers. If the speed of actual otoconia is anything like that of this simulator then all the Epley tutorials that say "wait 30 seconds" would seem to be way too fast to change positions.

Great webcast, I always learn so much here, please keep doing these. I was at a course where Dr. Staubb from Mayo Clinic gave an hour lecture on PPPD, PTS can find him on KZbin. We need a team effort in treating these patients and the challenge with CBT , is sometimes they are 3 months out in accepting new patients.

Edited to add that I've been allocated a @ tag/address/handle (or whatever it is) in this post that I don't use and I have no idea how to get rid of it. I would be grateful for a response to my comments when you have time but don't know if I will receive a notification if I get one. I am not very tech savvy when it comes to all this which puts me at a disadvantage regarding my access needs. Hi @Vestibular First and many thanks for this informative talk which I only just heard about via one of the VM groups. One of the key differences between MdDS and the symptoms of PPPD is that p/w MdDS (which I had on and off for many years) generally feel a reduction of symptoms (or complete relief from them) when we are re-exposed to passive motion (irrespective of any character traits or hormone status, as far as I can tell) whereas people with the symptoms associated with PPPD generally feel worse in motion. My concern about PPPD is that it is being over diagnosed in some clinics and MdDS is being under diagnosed and that in some cases people with MdDS have had their diagnoses changed to PPPD via re-issued clinical letters, without any further consultations taking place. In some instances it is being diagnosed before people even walk through the door, based on a previous episode of 'dizziness' alone. I really appreciate that Dr Goebel gives his patients literature about PPPD but am concerned that there was no patient representation in the FND Subtypes paper so hope he and other clinicians have raised their concerns about this. I agree that we need more debate since the PPPD researchers are now tweeting things along the lines of 'a broad or imperfect term is still more clear and useful than none, provided people understand it as such and are working to refine it' but I don't think this understanding is being clearly communicated to patients. It is unfortunate that the FND Society's approach to debate and patient engagement was, in my experience, very poor and I am also aware that Prof O'Leary has noted that FND ed is 'reckless' so the practice is 'reckless' too. Meanwhile Prof Kanaan's 'territorial expansion' commentary (which was published alongside the Subtypes paper) is now mostly behind a paywall but he kindly sent me the full document and, from the patient perspective, I have many concerns about it which need unpacking, preferably by patients and doctors together. A FAQ in the PPPD group I'm in (I don't have pppd but do have mild orthostatic intolerance which I think could easily be misdiagnosed as PPPD) is 'are there any eminent doctors from the various specialisms involved (eg neuro-otology, neurology, neural ophthalmology, psychiatry etc etc) who have accepted a pppd dx? If it's as common as everyone says it is, there must be at least one.' So, if you know of any, I'd be very grateful if you can let me know who they are. Meanwhile a paper that maybe should be circulated more widely (again, amongst patients and doctors) is this: www.qxmd.com/r/35481262

💞 þrðmð§m

very informative, thank you

Great teaching tool.

Appreciate the info on upright testing as there currently isn’t a great way to assess VBI. So, is there no combination of head movements? For example, neck rotation with slight extension? Or in these tests neck rotation with head roll (lat flex)? Should we add the shoulder abduction? Do you recommend a doppler at all or just DSA?

Great lecture! Keep this up! :)

Great class !! Congratulations!!

Thank you for another very helpful Journal club

I have had great success as well having patients video their eyes during spells at home. An outstanding tool for a variety of reasons. Great video!

Outstanding broadcast! Dr Goebel rocks! (Not in the otoconia way). Whenever I have patients with acute forms of vertigo, I work extra hard at providing good dizziness neuroscience education using analogies, stories, and motivational education. My goal is to prevent acute vertigo from becoming chronic. It would be interesting to study acute vertigo patients who may have tendencies toward 3PD comparing those who receive dizziness neuroscience education with those who do not receive it. I think we can learn from the chronic pain world and pain neuroscience education initiatives.