Presentation on theme: "Physical Therapy in the DoD"— Presentation transcript:
1Physical Therapy in the DoD CDR Henry McMillan, PT, DPTLCDR Alicia Souvignier, MPT, DPT, GCS
2ObjectivesIdentify the common patient presentations seen by PHS PTs working in the DoDBe able to indentify key aspects of the evaluation of a dizzy patientList 3 treatment techniques used to treat dizziness
3Indentification of mTBI Incident in theatre results in Medivac to CONUSAfter redeployment, troops inprocess through the Soldier Readiness Center, where history of concussion is identifiedSoldiers with possible residual symptoms of concussion, are referred to the TBI clinic.Mace, Warcat, multidisciplinary team
4DoD/Physical Therapy Optimistic expectation for full recovery Therapists incorporate assessment of the Service Members goals and priorities along with MTBI related symptoms
5Areas of concern for a soldier who has a history of concussion/mTBI Vestibular DysfunctionBalance ComplaintsPost Traumatic HeadacheTemporomandibular Joint DysfunctionAttention and Dual-Task DeficitsFitness/ Activity intoleranceMusculosketetal complaints
6Guidelines for PT Referral DHI Score > 11 (Yes to any F’s or P’s)Plus yes to one of the following:R/SR (Eyes Closed) less than 30 seconds- (arms across chest)VOR x1 for less than one minute with onset of symptomsWalking with HT increase symptoms, deviated gait, LOB- (Museum Gait)DHI Handout.
7Guidelines for PT referral If the patient reports any of the followingDifficulty with balance or dizziness that is affecting their functional performanceUnsteady while standing still or walking, in poor lighting, or in crowdsDifficulty with balance on uneven surfacesIntense spinning, lightheadedness, or unsteadiness associated with exercise
9Evaluation Subjective MOI or idiopathic Frequency/Intensity/duration Vision/ Hearing deficitsPositional/activity inducedValsalva/ pressure changesDescribe symptoms of dizzinessVertigoImbalanceLightheadedness
10Evaluation Subjective Activity Level Exercise Tolerance Recreational SportsExercise ToleranceUnit Physical TrainingBehavioral HealthQuality of LifeDHIFamily ParticipationCommand/Unit Support
13Oculomotor Vestibular Ocular Reflex Vestibular system sends information regarding speed of movement to the visual system. Allows us to keep focus while performing functional head motions.
14Test for VOR Head Thrust Test Grasp patients head firmly Tilt patient’s head to 30 deg flexMove head back and forth slowly and instruct patient to keep focus on targetProvide a quick movement through a small range and watch for patient’s ability to refocus on target.Refixation saccade indicates decreased VOR
16Test for VOR Dynamic Visual Acuity Test visual acuity on a Snellen ChartTurn patients head vertical and horizontal plane to the beat of a metronome at 2HzRetest visual acuity while you are moving the patient’s head.3 lines loss is significant
17Positional Testing Dizziness caused by certain positions Dix Hallpike SpinningUse Frenzal gogglesDix HallpikeBPPVMotion Sensitivity QuotientMotion Sensitivity
18Positional Testing Dix Hallpike Long sitting, head turned 45 deg, drop down with neck into about 30 deg of extension
19Balance Functional Gait Assessment Romberg/ Sharpened Neurocom or M-CTSIB
20Treatment ApproachesAdaptation Exercises: adapting residual vestibular function to make up for lost functionExample: Maintain visual fixation on object while the head is movingSubstitution ExercisesDoing exercises with and without visual cuesHabituation ExercisesRepeated exposure to provocative stimulus, for example motion sensitivity.
21VOR Treatment - Adaptation Walking head turnsTracking with eyesTracking with head movementsAll of the above togetherAbove exercises on varied surfaces
22Motion Sensitivity Treatment Brandt Daroff (picture)Positions identified from MSQAdd picture
23Treatment of BPPVCanalith Repositioning TechniqueLiberatory Maneuver
24Postural Stability Prioprio Neurocom- Balance activities- SOT Foam Unstable surfaceUneven terrainSlide for balance, one slide for proprio, one for neurocom