Recurrent Vertigo Dysequilibrium

Details

Title

Recurrent Vertigo Dysequilibrium

Type

Stage Two

Module code

HPS248

Requirement

Compulsory

Module objective

By the end of this module Clinical Scientists in HSST, with respect to recurrent vertigo/dysequilibrium, will be able to analyse, synthesise, evaluate and apply knowledge and perform a specialist assessment and treatment of patients with recurrent vertigo or dysequilibrium demonstrating the attitudes and behaviours necessary for the role of a Consultant Clinical Scientist within a patient focused service and in particular will be able to: 

• determine the cause of the recurrent .vertigo or dysequilibrium
• identify and address factors hindering vestibular compensation.
• determine any disability conferred by symptoms.
• select appropriate audiovestibular investigations.
• instigate appropriate management and refer when necessary.

Knowledge and understanding

By the end of this module Clinical Scientists in HSST will analyse, synthesise, evaluate and apply their expert knowledge required with respect to: 

• the sensorimotor physiology involved in balance maintenance.
• the causes of peripheral and central vestibular disorders with remitting and relapsing courses.
• types of pathology possible in other stabilising sensory and motor effector systems.
• the various factors hindering vestibular compensation.
• the psychological impact of recurrent disequilibrium.
• local and national protocols and guidelines for audiovestibular testing and other investigation.
• the pharmacological options, physical rehabilitation and psychological/psychiatric interventions.
• anatomy and physiology of the vestibular system, vestibular pathways, and central vestibular control centres and how these maintain good balance and are influenced by metabolic disorders.
• medication used to treat acute and recurrent vertigo, its pharmacological effect on the body, prescribing details and side effects.

Technical and clinical skills

By the end of this module Clinical Scientists in HSST, with respect to recurrent vertigo/dysequilibrium, will be able to demonstrate a critical understanding of current research and its application to the performance and mastery of the following technical skills:

• perform a detailed neuro-otological examination within the scope of a Consultant Clinical Scientist including an accurate examination of eye movements, characterising any nystagmus.
• distinguish peripheral from central vestibular causes of recurrent vertigo by selecting and interpreting appropriate audiovestibular tests from the following:
  • videonystagmography.
  • postural sway measurements, including Equitest.
  • tests of oculomotor function
  • tests of vestibulo-ocular function e.g. Halmagyi, head shaking, visual dynamic acuity
  • positioning tests including the Dix Hallpike manoeuvre.
  • caloric function testing including air calorics.
  • bedside test battery to identify signs distinguishing central from peripheral causes of recurrent vertigo/dysequilibrium.
  • vestibular evoked myogenic potentials (VEMPs).
  • hyperventilation evoked nystagmus
• systems for ensuring the quality assurance of test procedures.
• use of appropriate internal controls and performance monitoring including internal and external quality assurance.
• validity and reliability of test results and their application.
• managing uncertainty of measurement.hyperventilation evoked nystagmus
• use of systems to produce timely, accurate and relevant reports with appropriate interpretative comments.

By the end of this module Clinical Scientists in HSST will be expected to critically reflect and apply in practice a range of clinical and communication skills to advise and communicate effectively with patients, their family members or carers, clinicians, and other healthcare professionals and will:

• take an accurate history and perform a focused clinical examination as appropriate in the role of Consultant Clinical Scientist in order to identify the cause of the disorder and any factors hindering compensation.
• discuss and advise on therapeutic options e.g. diet restrictions for patients with Meniere’s disease, vestibular rehabilitation.
• devise and implement a programme of vestibular rehabilitation tailored to the individual, monitoring and reappraising management in line with progress working with the multi-disciplinary team including:
  • particle repositioning manoeuvres e.g. Epley, Semont.
  • instructing the patient in appropriate vestibular rehabilitation e.g. Cawthorne-Cooksey, Brandt-Darroff and visual exercises.
• request appropriate imaging to investigate recurrent vertigo/dysequilibrium, when indicated, and act appropriately on the findings.
• refer appropriately to other members of the multi-disciplinary team for effective management.
• recognise the possibility of any associated psychiatric or psychological symptoms.
• suspect any general medical or neurological causes of recurrent vertigo by a good history and focused examination as appropriate in the role of Consultant Clinical Scientist and refer as appropriate.
• within scope of practice, provide advice on medication for recurrent vertigo due to, Meniere’s disease or migrainous vertigo.
• judge correctly as to when fitness to drive/work is affected and counsel the patient appropriately. refer appropriately to other members of the multi-disciplinary team for effective management.
• reflect on the challenges of applying research to practice in relation to these areas of practice and suggest improvements, building on a critique of available evidence.

Attitudes and behaviours

By the end of this module Clinical Scientists in HSST will be expected to evaluate their own response to both normal and complex situations demonstrating the professional attributes and insights required of a Clinical Scientist in HSST working within the limits of professional competence referring as appropriate to senior staff and will:

• appreciate the distress and disability caused by recurrent vertigo or dysequilibrium and demonstrate a sensitive approach to the patient.
• recognise the impact of recurrent vertigo or dysequilibrium in a patient with additional medical needs.
• recognise the value of the multidisciplinary approach to patient assessment and management.
• maintain patient confidentiality throughout investigations and reporting of outcomes.
• promote the importance of active participation by Clinical Scientists in multidisciplinary clinical team meetings.
• be committed to and support continuous improvement of therapeutic services, with particular reference to auditing practice, evidence based practice, innovative, new and improved technologies.