Cervical Masterclass: Cervicogenic Dizziness ... · Sue has completed her PhD and a research masters on the identification and treatment of people with cervicogenic dizziness and

1 day course Cervical Masterclass: Cervicognenic Dizziness & Differential Diagnosis.

Cervical Masterclass: Cervicogenic Dizziness &

Differential Diagnosis. Includes post-concussion syndrome

HOW DO WE ASSESS AND TREAT A PATIENT WITH

CERVICOGENIC DIZZINESS

COURSE DATE: MONDAY 20 MAY 2019 VENUE: Science Centre London Metropolitan University 29 Holloway Road London N7 8DB You will be met at the Science Centre Reception (29 Hornsey Road) FEE: £130.00 per person

TUTOR: DR SUE REID

PhD MMedSc(Phty), GradDipManipTher,BAppsSc(Phty),BPharm Qualifications Sue is a senior lecturer in musculoskeletal physiotherapy at the Australian Catholic University in North Sydney where she teaches undergraduate Physiotherapy students. In the past she has taught anatomy to Physiotherapy and Medical students. Experience She is a Titled Musculoskeletal Physiotherapist, a certified Mulligan practitioner and member of the Mulligan Concept Teachers Association (Honorary) with post graduate training in the Mulligan Concept, as well as the the Maitland and McKenzie physiotherapy methods. Sue has completed her PhD and a research masters on the identification and treatment of people with cervicogenic dizziness and pain. This has also involved the diagnosis and treatment of dizziness from other causes such as the vestibular system and vertebral artery. She is currently doing research on the assessment and management of people with ongoing sports related concussion symptoms. Her other research topics are ‘Text Neck’, proprioceptive and balance disturbances in people with neck pain, and neurodynamic testing in the upper limb. She has just completed a randomised controlled trail on addition of Mulligan glides to exercise and advice, after a distal radius fracture. She has published in international journals, written a textbook chapter and presented and run workshops at many international conferences such as WCPT, IFOMT and the International Mulligan Conferences. Her clinical interests are the treatment of neck pain, dizziness, headaches, concussion and TMJ problems.


Publications by Sue Reid Book Chapter Reid Susan, Rivett Darren Anthony, ‘A diagnostic dilemma of dizziness’, In Vicenzino, B., Hing, W., Rivett, D.A. and Hall, T. (2011) Mobilisation with movement: The art and the science, Elsevier Australia, Chatswood, NSW, 114-122. Journal publications Reid SA & Rivett DA. (2005) Manual therapy treatment of cervicogenic dizziness: a systematic review. Manual Therapy, 10:4-13. Reid SA, Rivett DA, Katekar MG & Callister R. (2008) Sustained natural apophyseal glides (SNAGs) are an effective treatment for cervicogenic dizziness. Manual Therapy, 13:357–366. Reid SA, Rivett DA, Katekar MG & Callister R. (2012) Efficacy of manual therapy treatments for people with cervicogenic dizziness and pain: protocol of a randomised controlled trial. BMC Musculoskeletal Disorders, 13:201-208. Reid SA, Rivett DA, Katekar M & Callister R. (2014) Comparison of Mulligan Sustained Natural Apophyseal Glides and Maitland Mobilizations for Treatment of Cervicogenic Dizziness: a Randomized Controlled Trial. Physical Therapy, 94:466-476. Reid SA, Rivett DA, Katekar M & Callister R. (2014) The Effects of Cervical Spine Manual Therapy on Cervical Range of Motion, Head Repositioning and Balance in Participants with Cervicogenic Dizziness: A Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation, 95:1603-12. Reid SA, Callister R, Snodgrass SG, Katekar MG & Rivett RA. (2015) Manual therapy treatment of cervicogenic dizziness: long-term outcomes of a randomised controlled trial. Manual Therapy, 20:148-156. Reid SA, Callister R, Katekar MG, Treleaven JM. (2017) Utility of a brief assessment tool developed from the Dizziness Handicap Inventory to screen for Cervicogenic dizziness: A case control study. Musc Science and Practice, 30: 42-48 Reid SA. (2017)Neck Dizziness. Phone App on Android and Apple devices

Learning Objectives:

On completion of this session you should be able to: • Understand what cervicogenic dizziness is and how it differs from other types of

dizziness. • Interview a person with neck pain and dizziness • Perform a physical assessment of the cervical spine with emphasis on assessment of the

upper cervical spine. • Assessment of VBI • Assessment of people with prolonged symptoms after a concussion injury. Treatment of

patients with cervicogenic dizziness, prolonged post-concussion syndrome and BPPV This workshop will include

1) Review of dizziness and its classification, types and causes 2) What is cervicogenic dizziness 3) How we identify cervicogenic dizziness 4) Case study (This will be followed through the examination for clinical

reasoning) 5) Patient Interview to identify cervicogenic dizziness

Establishing: - neck dysfunction - type of dizziness is unsteadiness and not rotatory dizziness - neck movements and if they trigger dizziness - recognize other causes of dizziness such as cardiovascular dizziness, vestibular problems, Benign Paroxysmal Positional Vertigo (BPPV), vertebra-basilar insufficiency (VBI) and migraines


Use of short questionnaire (Reid et al 2017) and phone app to identify those with cervicogenic dizziness.

6) Physical evaluation of cervical spine, emphasizing upper cervical spine and assessment to determine if dizziness is possibly coming from the neck

a. Active range of motion (ROM) with over pressure especially of the upper cervical spine b. Passive accessory palpation examination of the cervical spine with passive accessory inter

vertebral movements (PAIVMS) (central and unilateral and transverse passive accessory glides) as described by Geoff Maitland

c. Passive physiological intervertebral movements (PPIVMS) for upper and lower cervical spine d. Clinical tests to rule in or out cevicogenic dizziness such as the Smooth Pursuit Neck Torsion

Test e. Assessment of BPPV with Dix-Hallpike manoeuvre f. Assessment of ligaments in upper cervical spine e.g. Sharp-Purser, alar ligament and

tectorial membrane tests g. Vestibular Ocular Motor Screening (VOMS) h. Assessment of cervical spine proprioceptive deficits with head repositioning testing i. Assessment for VBI: Assessment for cardio vascular dizziness

7) Treatment Treatment of cervicogenic dizziness

a. Sustained Natural Apophyseal Glide (SNAG) for extension b. SNAG for rotation c. Self-SNAGs d. Passive joint mobilization

Assessment of patients with persistent symptoms after a concussion injury. Discussion of symptoms post sports concussion: dizziness, headache, neck pain, visual disorders, fatigue, irritability and fogginess. Assessment Treatment of individuals with prolonged post-concussion symptoms

a. Graded exercise b. Treatment of cervical spine c. Treatment of occulo-motor dysfunction d. Balance exercises e. Vestibular rehabilitation f. Treatment of proprioceptive deficits

Treatment for BPPV

a. Epley manoeuvre b. Brandt-Daroff exercises


Cervical Masterclass: Cervicognenic Dizziness & Differential Diagnosis

Includes post-concussion syndrome

SCIENCE CENTRE LONDON METROPOLITAN UNIVERSITY

MONDAY 20 MAY 2019

PROGRAMME

8.30 Registration/Coffee

Part A: Cervicogenic Dizziness

9-10.30 Morning Session 1

9-9.30 Lecture

• Review of dizziness and its classification, types and causes

• What is cervicogenic dizziness and how it differs from other types of dizziness

• Recognize other causes of dizziness such as cardiovascular dizziness, vestibular problems, Benign Paroxysmal Positional Vertigo (BPPV), vertebro-basilar insufficiency (VBI) and migraines

• How we identify cervicogenic dizziness

• Use of short questionnaire (Reid et al 2017) and phone APP to identify those with cervicogenic dizziness.

• How to interview a person with dizziness and neck pain

• Case study (will be followed through the examination for clinical reasoning)

9.30-10.30 Performing a physical assessment of cervical spine, emphasizing upper cervical spine -Practical session

• Active range of motion (ROM) with over pressure including upper cervical spine

• Palpation of soft tissues


• Passive accessory palpation examination of the cervical spine with passive accessory inter vertebral movements (PAIVMS) (central and unilateral and transverse passive accessory glides) as described by Geoff Maitland

• Passive physiological intervertebral movements (PPIVMS) for upper and lower cervical spine

• Clinical tests to rule in or out cervicogenic dizziness such as the Smooth Pursuit Neck Torsion Test, Cervical Flexion Rotation Test

10.30-11 Coffee

11-12.45 Morning Session 2

11-11.45 Performing a physical assessment - Practical session (cont)

• Assessment of cervical spine proprioceptive deficits with joint position sense testing (laser),

• Cranio-cervical flexion test (CCFT)

• Balance testing

11.45-12.45 Treatment of patients with cervicogenic dizziness – Lecture 10 mins then practical session

• Evidence for treatment of cervicogenic dizziness

• Sustained Natural Apophyseal Glide (SNAG) for extension

• SNAG for rotation

• Self-SNAGs

• Passive joint mobilization

12.45-1.30 Lunch

Part B Differential Diagnosis

1.30- 3.30 Afternoon Session

1.30-2.15 Vestibular dizziness, BPPV, central dizziness (Lecture and prac)

• Assessment of BPPV with Dix-Hallpike manoeuvre

• Epley manoeuvre

• Brandt-Daroff exercises


•

2.15-3.30 Post-concussion Syndrome: assessment and treatment (Lecture 45 min , practical session 30mins)

Includes vestibular ocular motor screening (VOMS), near point convergence, Optokinetic testing, evaluation of exercise tolerance

Treatment of individuals with prolonged post-concussion symptoms

• Cervical interventions

• Treatment of proprioceptive deficits

• Treatment of ocular motor dysfunction

• Balance exercises

• Vestibular interventions

• Exercise rehab

3.30-4.00 Coffee

4.00 -5.00 Afternoon Session 2 (Lecture and practical session)

• Vertebro-basilar insufficiency (VBI) and craniocervical arterial dissection (CAD). Assessment for VBI: including latest guidelines from IFOMPT and Aust Physio Association

• Assessment of ligaments in upper cervical spine e.g. Sharp-Purser, alar ligament and tectorial membrane tests

• Migraine

• Assessment for cardio vascular dizziness

• Questions and Finish


Directions to venue Science Centre London Metropolitan University 29 Holloway Road London N7 8DB You will be met at the Science Centre Reception (29 Hornsey Road) which on the left about 400 yards before the stadium. By underground – Holloway Road Tube Holloway Road Tube is the nearest underground station. Upon exiting the tube, cross the road and head straight across the cross-roads towards the Emirates Stadium. By car – For parking information please follow link https://en.parkopedia.co.uk/parking/school/london-metropolitan-university/?arriving=201812191430&leaving=20181219163 Finding somewhere to eat Although refreshments are included in course, lunch is not included There are 3 cafes on site; one in the library next door and the other two in the main building on Holloway Road. There are also numerous local independent cafes as well as a Costa, Pret etc.

1-day on course – 7 hours CPD certificate handed at end of course signed by tutor


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Documents

Cervical Masterclass: Cervicogenic Dizziness ... · Sue has completed her PhD and a research masters on the identification and treatment of people with cervicogenic dizziness and