presented by Laura Morris
This course is part of our NCS Prep-Program. Learn more about the full prep-program here: MedBridge NCS Prep-Program.
The central vestibular system is diffuse and is integrated into many different areas of the brain stem, cerebellum, spinal cord and cortex. There are many places along the pathways that are vulnerable to pathology, both acquired and traumatic. This course will describe the pathological conditions that may affect the central vestibular pathways. Differential diagnosis of central pathology is presented. Examination, evaluation, prognostic indicators and general intervention guidelines are discussed.
Laura Morris, PT, NCS is a physical therapist and lecturer with 25 years of experience in the management of adults with neurologic disorders. Her clinical work focuses on vestibular disorders and mild traumatic brain injury at Elmhurst Memorial Hospital in the Chicago area. She is the Director of Communications for the Academy of Neurologic PT of the APTA. She teaches continuing education in concussion and vestibular rehabilitation both nationally and internationally. Her experience includes inpatient and outpatient care, clinical research and program development, including the launch of the fourth credentialed Neurologic PT Residency Program in Pittsburgh. Clinical practice also included vestibular and concussion rehabilitation in Pittsburgh, Pennsylvania, the Mild Brain Injury Program in Baltimore, Maryland and neurologic private practice in Alexandria, Virginia. She was re-credentialed for her as a Neurologic Clinical Specialist in 2013. She has been involved in the Academy of Neurologic PT and the Vestibular special interest group, primarily in positions involving website support. In 2005 she received the Award for Clinical Excellence in Neurology by the Neurology Section of the APTA, and in 2015 received the Service Award from the Vestibular Special Interest Group. Her contributions to the literature include book chapters and journal articles in the area of vestibular disorders and mild brain injury rehabilitation.
Focal lesions in the vestibular nuclei, brainstem, thalamus and cortex can cause significant postural control impairments, dizziness and functional mobility dysfunction. These lesions cause impairments that are based upon the anatomy that they affect, so knowing the underlying anatomy helps to identify the impairment. In this chapter, a few types of vestibular impairment are discussed, including information that is helpful for differential diagnosis.
Traumatic brain injury can affect the vestibular system, either by direct trauma to the skull, causing fractures, by direct trauma/hemorrhagic lesions, or by the more diffuse dysfunction that happens during concussion. The accompanying sequelae of signs and symptoms can make vestibular impairment difficult to discern. This chapter reviews TBI as it relates to the vestibular system and reviews some ways in which the vestibular system is affected by TBI.
Vestibular migraine is a common cause of dizziness. Due to the diffuse nature of migraine symptoms, it is challenging to identify vestibular migraine. This chapter will review the pathophysiology and central structures affected by migraine, the diagnostic criteria for vestibular migraine, and management considerations.
Persistent postural-perceptual dizziness occurs due to changes in the brain that result in chronic symptoms of disequilibrium and dizziness. Psychologic conditions play a role in the development of PPPD. A clear understanding of the pathophysiology and diagnostic criteria for PPPD will help in managing this challenging diagnosis.
The conclusion of this course focuses on the general oculomotor changes that occur with vestibular migraine and a review of the management guidelines for those with central vestibular disorders. A brief review of the rehabilitation efficacy research in central vestibular disorders will also be presented, followed by a summary of this course.