Reviewing: S-A-S4-1

Vestibular

Information:

Module information

Details

Title
Vestibular
Type
Specialist
Module code
S-A-S4-1
Credits
10
Requirement
Compulsory

Aim of this module

To provide trainees with the necessary theoretical background and practical skills to safely assess and manage a range of common vestibular deficits in adults without significant co-morbidities.

Work-based content

Competencies

# Learning outcome Competency Action
# 1 Learning outcome 1 Competency

Obtain a detailed diagnostic clinical history from complex vestibular cases with co-morbidities

 Action View
# 2 Learning outcome 3, 5 Competency

Safely perform the following diagnostic tests and select and perform appropriate repositioning manoeuvres based on the findings:

  • Dix-Hallpike test
  • Rose test
  • Horizontal roll test
 Action View
# 3 Learning outcome 2, 3 Competency

Select and safely perform the following standard diagnostic tests:

  • Videonystagmography, including static body positional testing and headshake test
  • Caloric testing (with the aid of an assistant)
  • Video head impulse test
  • Vestibular-evoked myogenic potential testing (either cervical or ocular)
 Action View
# 4 Learning outcome 2, 3 Competency

Interpret and integrate results from the following standard tests to formulate a differential diagnosis:

  • Videonystagmography, including static body positional testing and headshake test
  • Caloric testing (with the aid of an assistant)
  • Video head impulse test
  • Vestibular-evoked myogenic potential testing (either cervical or ocular)
 Action View
# 5 Learning outcome 2, 3 Competency

Discuss the role of the following specialist diagnostic tests, and how they are performed and interpreted, with a qualified clinician:

  • Static and dynamic posturography
  • Rotational testing
  • Subjective visual vertical
  • Computerised dynamic visual acuity test
  • Office tests of cerebellar function including the vestibulo-ocular reflex suppression test
  • Vibration-induced nystagmus tests
 Action View
# 6 Learning outcome 3, 4 Competency

Debrief patients and their significant other to explain the test results, and where appropriate the treatment, prognosis, and aetiology, of the following common test findings:

  • Unilateral vestibular weakness
  • Bilateral vestibular weakness
  • Central findings
  • BPPV
  • Normal results with a positive vestibular history
 Action View
# 7 Learning outcome 7 Competency

Make appropriate onward referrals to one of the following related specialties:

  • Physiotherapy
  • Neurology
  • ENT
  • Psychology
  • Elderly care/falls prevention service
 Action View
# 8 Learning outcome 5, 6 Competency

Develop a holistic and individualised vestibular rehabilitation programme for routine patients

 Action View
# 9 Learning outcome 5, 6 Competency

Evaluate and modify vestibular rehabilitation programmes for routine patients

 Action View
# 10 Learning outcome 8 Competency

Write accurate and concise reports for:

  • Vestibular assessment
  • Vestibular rehabilitation
 Action View

Assessments

Complete 2 Case-Based Discussions

Complete 2 DOPS or OCEs

Direct Observation of Practical Skills Titles

  • Safely and accurately perform a caloric test (with the aid of an assistant if required).
  • Safely and accurately perform a cervical or ocular vestibular evoked myogenic potential test.
  • Safely perform a vestibular rehabilitation exercise assessment.

Observed Communication Event Titles

  • Explain a diagnosis of BPPV to a patient and their significant other(s), including an explanation of treatment options.
  • Take a detailed vestibular rehabilitation case history from a patient.
  • Use shared decision making to set appropriate goals for a vestibular rehabilitation programme.

Learning outcomes

# Learning outcome
1

Collect a detailed patient history which informs an individualised test strategy and rehabilitation plan.
2

Perform vestibular assessments making safe and appropriate adaptions to the test approach to suit the needs of the patient.
3

Perform and interpret a wide range of diagnostic vestibular tests.
4

Discuss test results in an appropriate and sensitive manner according to the needs of the patient, taking into account differing cultural and social attitudes to hearing care.
5

Provide safe and effective vestibular rehabilitation for commonly occurring disorders in patients without significant comorbidities.
6

Evaluate vestibular rehabilitation options for complex cases with comorbidities.
7

Practice within their own personal and professional scope, identifying where onward referral is appropriate.
8

Prepare reports and document test findings and rehabilitation plans.

Academic content (MSc in Clinical Science)

Important information

The academic parts of this module will be detailed and communicated to you by your university. Please contact them if you have questions regarding this module and its assessments. The module titles in your MSc may not be exactly identical to the work-based modules shown in the e-portfolio. Your modules will be aligned, however, to ensure that your academic and work-based learning are complimentary.

Learning outcomes

On successful completion of this module the trainee will be able to:

  1. Investigate possible vestibular pathologies and their impact on the adult patient.
  2. Apply integrative understanding to interpret a vestibular case history, and devise assessment plans as appropriate.
  3. Interpret and synthesise vestibular test results, and use the evidence base to develop a differential diagnosis.
  4. Devise holistic patient management plans and critically evaluate the evidence base for management options for vestibular conditions.

Indicative content

Learning Outcome Indicative content
Investigate possible vestibular pathologies and their impact on the adult patient
  • Impact of vestibular conditions on patients and their significant others
  • Vestibular history-taking (including physical, psychological, and functional aspects)
  • Changes in vestibular function with ageing
  • Pathophysiology of vestibular conditions
Apply integrative understanding to interpret a vestibular case history, and devise assessment plans as appropriate
  • National and international policies, guidelines, position statements, consensus, and best practice
  • Test procedures and clinical use of vestibular function tests including, but not limited to:
    • Positioning tests
    • Oculomotor testing using videonystagmography
    • Static positional tests
    • Caloric testing
    • Video head impulse testing
    • Vestibular evoked myogenic potential testing
    • Rotation chair testing
    • Computerised posturography
    • Subjective visual vertical
    • Computerised dynamic visual acuity test
    • Office tests of cerebellar function including the VOR suppression test
    • Vibration-induced nystagmus tests
Interpret and synthesise vestibular test results, and use the evidence base to develop a differential diagnosis
  • Test result interpretation, including limitations and inter-relationship of tests
  • Synthesis of the test battery results
  • Differential diagnosis of vestibular conditions, including but not limited to:
    • Vestibular neuritis
    • Meniere’s disease
    • Benign paroxysmal positional vertigo
    • Vestibular migraine
    • Labyrinthitis
    • Chronic vestibulopathy
    • Bilateral vestibular hypofunction
    • Third window syndromes
    • Mal de debarquement syndrome
    • Central vestibular lesions
    • Vestibular schwannoma
    • Persistent postural perceptual dizziness
    • Vestibular paroxysmia
Devise holistic patient management plans and critically evaluate the evidence base for management options for vestibular conditions
  • Rehabilitative history approaches
  • Holistic management approaches
  • Exercise-based vestibular rehabilitation
  • Principles and application of shared decision-making
  • Outcome measures
  • Transdisciplinary working (e.g. falls team and psychological interventions)
  • Sources of support (e.g. charities)
  • Multi-disciplinary/-professional working for patients with vestibular conditions
  • Reflective practice

Clinical experiences

Important information

Clinical experiential learning is the range of activities trainees may undertake in order to gain the experience and evidence to demonstrate their achievement of module competencies and assessments. The list is not definitive or mandatory, but training officers should ensure, as best training practice, that trainees gain as many of these clinical experiences as possible. They should be included in training plans, and once undertaken they should support the completion of module assessments and competencies within the e-portfolio.

Activities

  1. Attend a local multidisciplinary falls prevention, elderly care, syncope/blackout or geriatric medicine clinic.
  2. Attend a local vestibular/balance patient support group.

Module assigned to

Specialties

Specialty code Specialty title View
Specialty code SPS2-1-23 Specialty title Audiology [2023] Action View
Specialty code SPS2-1-24 Specialty title Audiology [2024] Action View
Specialty code SPS2-1-25 Specialty title Audiology [2025] Action View
Specialty code SPS2-1-22 Specialty title Audiology [2022] Action View
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