A physical therapist classification system for persons with complaints of dizziness and balance dysfunction

Abstract

Background: Dizziness is a very challenging condition to diagnose and treat. Patients with dizziness are increasingly consulting physical therapists in direct access clinics, and commonly require vestibular rehabilitation exercises (VREs). To optimize the effect of VREs, physical therapists should be able to determine whether the patient with dizziness is appropriate for VREs or should be referred to other healthcare providers. Objectives: The purpose of this paper is to describe a screening procedure that will assist physical therapists in the clinical decision-making process for the person presenting with dizziness in direct access clinics. Major Findings: Patients with dizziness can be classified into three subgroups: red flags, yellow flags, and green flags. Red flags are patients with dizziness for whom VRE intervention is not appropriate unless a physician has already cleared them. Yellow flags are patients with dizziness who can benefit from a VRE intervention, however, they present with comorbid disorders that warrant consultation with other healthcare practitioners in order to maximize the effect of the VRE intervention. Green flags are patients who will benefit from VRE intervention without referral. Conclusions: The screening procedure classifies patients with dizziness into three subgroups: red flags, yellow flags, and green flags. Red flags are patients with dizziness for whom VRE intervention is not appropriate unless a physician has already cleared them. Yellow flags are patients with dizziness who can benefit from a VRE intervention, however, they present with comorbid disorders that warrant consultation with other healthcare practitioners in order to maximize the effect of the VRE intervention. Green flags are patients who will benefit from VRE intervention without referral.

Clinical Decision Making in the Management of Patients With Cervicogenic Dizziness: A Case Series

“…16,41,77 As a cohort, patients did not demonstrate abnormal signs that suggested either central or peripheral vestibular pathology, such as unilateral/ bilateral vestibular dysfunction, Ménière's disease, Arnold-Chiari malformation, or cerebellar degeneration. 3,33,34,79,85 Negative findings from the Dix-Hallpike test and the roll test to suspect the possibility of BPPV presenting similar dizziness characteristics of CGD 85 elevated the competing hypothesis of CGD in 7 patients.…”

“…17,30,37,64 The combination of upper cervical distraction and suboccipital trigger point release (APPENDIX B, available at www.jospt. org) was common in relieving dizziness among patients (1)(2)(3)(4)(5). Cervical manual techniques progressed to reduce pain and stiffness regionally to the identified hypomobile level(s), especially within the upper cervical spine.…”