Welcome to Talk Dizzy to Me, the show that brings you a comprehensive look into the complex field of dizziness. Now here are your hosts, vestibular physical therapist, Dr. Abby Ross and Dr. Danielle Tolman. Welcome back to another episode of Talk Dizzy to Me. My name is Dr. Danielle Tolman. I'm a vestibular physical therapist.
And today is the first day, I think, since I've been doing this podcast, I am not joined by my co-host, Dr. Abby Ross, who's also a vestibular physical therapist and neuroclinical specialist. She's a little under the weather and there was just absolutely no way that we wanted to cancel or reschedule our guest today. I'm very excited to introduce Dr. Christina Garrity, who is going to talk to us today about all of the awesome things that she's doing in the clinic with research, the great videos that she's putting on Instagram.
So Christina, thank you so much for joining us today. Would you mind giving us a little bit of a background on you and what you do and where you are? Sure. Thanks for having me. Excited to be here.
Um, so I am a physical therapist. I'm an NCS. So I specialize in neurologic physical therapy. I graduated from the University of Dayton in 2012. So I've been a PT for a little bit over a decade and really got into neuro initially.
And that was my bread and butter. I did two years in inpatient rehab at a level one trauma center. So So got a lot of experience with stroke and brain injury and spinal cord injury and wanted to be able to follow my patients longer than just the two or three quick weeks.
So nearby where I live, there is an outpatient neurologic rehabilitation center, which is a fantastic location, great clinic, lots of good mentorship there. So when I had the opportunity to switch to that setting, I did. And during the hiring process.
I was really excited about the neuro piece and they said, you know, we would love to have you, but you have to do vestibular. And I was like, I am not one that loved vestibular right out of the gate, but I definitely caught the bug as things progressed. So I was kind of forced into the world of vestibular rehab, which is a really good thing. So I was sent to Emory to do their vestibular rehab course.
And then shortly after felt the need for more and went to UPMC to do their advanced vestibular course. And so for eight years following that, I was working in a neuro vestibular outpatient clinic doing 50% neuro, 50% vestibular, surrounded by 18 other PTs who were 11 of them had also gone through the same training. So I was in a setting that was really conducive to learning and mentorship.
And that really, I think, propelled my knowledge and understanding. of seeing some of these complex patients and cases. It also gave me a really nice perspective of the neurologic-vestibular crossover, which I find is really hard to separate.
If you're a neurologic physical therapist, you're probably a vestibular therapist, whether you want to be or not. So that was a really great experience for me. And then I, in the last couple of years, have been pulled into more of like the academic setting and teaching. and really enjoyed being able to share this knowledge with others and teach other providers and upcoming PT students.
And so last year I started my own clinic to give me a little bit more flexibility on treating patients kind of the way I wanted to treat them. The vestibular patient is special. Sometimes they need more time, they need more communication with me, more connection with me to help progress them.
So I started my own vestibular outpatient clinic to do that. And it also allowed me to adjust my schedule a little bit more so that I could continue to teach. So I did that for the last year. And unplanned, kind of surprisingly, ended up in a PhD program that started this August. So I'm in my first semester of my PhD at the University of Cincinnati and then in the clinic part time.
I have so many things to talk to you about today. You wear so many hats. I'm so jealous of your experience and the environments that you've gotten to work in.
I love what you're doing. Sharing some of that on Instagram, which is one of the first places that I got to see what you were all about and what was going on. And I love the stuff that you share.
A lot of your videos, there's a very, very clear sense of that neuro heavy crossover with vestibular therapy. And that's amazing. I think that's so important for a lot of this patient population. And then even just the idea of opening your own clinic to give this patient population a little bit more time, expertise, and that extra TLC that they need is amazing.
And then on top of that, adding in research and PPP and working with students. It's, oh my gosh, it's an aciduloholic dream. I know, right? You just have to juggle it all. But it's actually working out really well.
So happy with all the decisions I've made. Just have to. Keep going.
That's awesome. Well, I want to dive into some questions because I think there's a lot of really great information here that you have to give to our listeners. So first, let's just start with treatment selection for patients. You know, you go into your eval, what does that look like?
And how do you use that eval to create a treatment plan for the person that you're seeing in front of you? Yeah. So at the original clinic I was in for vestibular rehab, I was really spoiled. I had an ECHO test.
I had instrumentated, instrumentated, instrumentized DVA. And I could really, in one session, if I had the time, get all of this really good data on vestibular integration, the VOR. I had, we had four sets of goggles. So there were, you know, we had everything. And that really guides.
what you do. Your evaluation is so crucial in these patients, regardless of the specific vestibular diagnosis, you know, we're very functional based as PTs. And so our vestibular exam really tells us where we're going, what road are we going to go down with each patient. And then when I started my own clinic, I lost all of that because it's expensive, right? But at the same time, it's important to be able to do what we do without it because a lot of practitioners don't have it.
And how do we still get the information that we need? So when I started my own clinic, I did, you know, right away purchase goggles because I don't we can't do what we do without them. It's very important.
But then I learned how to do the DVA, you know, with the Snellen chart and do, you know, instead of an SOT, I do the modified CAT-SIB. I let the FGA guide me on their dynamic balance. And then I rely heavily on, you know, my ocular motor screen.
And. how's their head impulse test and use all of these components to build that vestibular picture that I was getting maybe a little bit more accurately at my old clinic, but I have found in the last year that I'm still able to provide the same level of intervention with what I'm using. And so that's been nice for me to have to make that transition because I can educate others on how to do it with very minimal equipment and very minimal space.
And still be very effective for these patients. So, yeah, that's the core of my vestibular exam. I would say it's your ocular motor exam. It's using the infrared goggles. Everyone gets screened for BPPV.
Then going into a dynamic visual acuity testing, modified CAT-SIF, functional gait assessment. And then if I need to, bringing in the motion sensitivity quotient to give me more direction on sensitivities, directional sensitivity. I was, I went through some very similar changes in recent years, leaving a clinic where I had computerized, you know, dynamic posturography.
I had goggles, I had an overhead support system, balance shuttles, you know, the whole bit. And I went to a clinic where I really didn't have any of that fun stuff, except for like an overhead support system. And then we kind of built that up. And then I changed jobs again. And I ended up working out of a I I think it was nine foot by 13 foot storage closet in an assisted living facility where I had a table, a set of goggles that I purchased myself and I made it work.
And, you know, finding that that difference in going from the high tech stuff to having nothing was actually a really big game changer for me and how I evaluated patients, but also made me a stronger clinician and having to get back to the roots and figure things out. But you're absolutely right. Whether you're somebody listening who has everything at your disposal or you're just starting out with nothing. and you're slowly starting to build things up, this is doable. You can still help this patient population.
There's ways around it. I love it. I love hearing that. Making that shift has also been a great thing for you too. Yeah.
So if we're looking at some of your treatments, could you just basically kind of touch on what you've emphasized in different approaches to treatment for different diagnoses, such as vestibular migraine or triple PD and malady debarkment? All very similar, but all very neurologically heavy with some overlapping qualities, but still a little different in some aspects. Yeah. So my treatment is really based on my functional findings during my exam.
So every time I do an evaluation component, I'm looking for abnormal findings, but I'm also very keen on asking them, did that make you nauseous? Did that make you dizzy? Or was that, you know, that? a foggy head feeling that you don't really like.
And I'm making like a list in my head on during DVA, it was normal, but they really didn't enjoy the way it made them feel. Then maybe their VOR is normal, but their sensitivity to using their VOR needs work. So that's going to go on the list.
And so it's, as you're going through your exam, you're not only looking for abnormal findings, but you're also making sure, is this triggering for their symptoms? Because that's really your playbook, right? It's giving you... the information you need to then design the treatment that's going to help their specific needs. And that's...
Maybe one of the more challenging things from vestibular rehab is I don't have like a prescripted exercise program. I have my principles in the foundation, but every patient needs something so different that I found when I prescripted, I was never using it anyways. So really letting my evaluation, as long as you do it correctly, is your playbook for every patient. You know, I was thinking when I started.
As a new PT, a lot of times when you're learning, you want to come into a session with, okay, this is what I'm going to do today for each patient. It gets you more comfortable walking into that room. You have a game plan. But I can honestly say that I don't have a single thing picked out for any patient that walks in the room until I've talked to them that day.
And the question is, okay, what went well this week? Because if you're noticing improvements in X, Y, and Z, then we're heading on the right path. but we're also maybe ready to progress X, Y, and Z to something more challenging? Or what were specific activities this week that triggered your worst dizziness spells?
And then that motion or that action I'm going to break down. Was that more bending over? Was it more up into the right or up into the left?
And then designing specific exercises that match their movement patterns that are triggering. So I don't really have like go-to exercises. I would say that I'm always breaking down vestibular rehab into three categories.
And that is gaze stabilization and what they need there, whether it's abnormal or just sensitive. And then it's vestibular integration. So how well are they using their inner ear?
And again, maybe their modified cat suit is normal. But when they're standing on foam with their eyes closed, they get that feeling return like, oh, I'm nauseous. I don't like this. then that still needs to be something I work on, even though they're able to do it. So gaze stabilization, sensory integration, and then habituation.
So what specific triggers or activities are triggering to you? Because that's the type of exercise I need to create for that particular patient. And I think I might be different. Maybe this is normal vestibular therapy. But when I'm doing an exercise...
program, I rarely am like, you're going to do this for 30 seconds for five reps a day. I try and really start my relationships with my patients by teaching them how to be their own vestibular therapist. So instead of a straightforward prescription, it's, this is how hard I want you to push yourself. This is the safe zone. This is the improvement zone.
And this is the no-go zone. because every day they could be changing and they have to know how to adapt that program to match what's going to make them successful and not be a waste of their time or, you know, potentially make things worse. And I think regardless on Meniere's, malday debarkment, 3PD, hypofunction, that approach is pretty straightforward. You know, it's very similar. Vestibular migraine is an outlier.
I... Definitely do a lot of education differences for vestibular migraine. I was listening to Dr. Madison Oak a couple of weeks ago on her podcast, and she explained vestibular migraine like a cup. And I totally stole that.
I love it. You know, your cup is this big and what different changes can we do, whether that's hydration, activity, different light changes, all kinds of diet changes to make your cup bigger. so that you can tolerate more things without overflowing into active migraine. I love that analogy.
So I definitely stole it. I don't think you could have given a more perfect answer to that question. And I relate to a lot of what you just said, you know, in a textbook world, it'd be great to be able to put down an exercise prescription and counting the metronome beats and how long the patient's doing it and kind of prescribe it, you know, um, uh, down to like the second on the, on the documentation that we do, but a lot of it does come down to functionality and how the patient's feeling, what's triggering that day, what you do on one day, maybe completely different from what you do on another day, depending on if they're symptomatic, if things were triggered, if they're having a bad symptom day due to changes in weather, because they ate something funky the night before, because they were celebrating a birthday, like you never know with these vestibular patients walking in the door, what kind of day it's going to be.
You know, as long as you're there. generally trending in the right direction. That's what we're looking for, but it keeps us on our toes because we're constantly changing the game. And I love the idea of working with patients to kind of figure out how to make things more difficult or how to stay within that therapeutic range, which is super duper important for the home exercise program.
Because if I have a patient who's feeling really, really symptomatic, I don't want them really driving up those symptoms by trying to do their exercise program to a T. But we talk about in the clinic ways to regress things or ways to progress things to keep that. level of challenge in a therapeutic zone and not pushing them too far. So everything that you just said is like on the money when it comes to working with vestibular patients, which is why we have you on today.
I think it's really beneficial to teach them, you know, what I actually go through, like, okay, this is your VOR and this is gaze stabilization training. This is vestibular integration and teaching your brain to use your vestibular system for balance. And then there's this other habituation technique.
that we need to also desensitize you to certain triggers. And I'll, you know, I kind of make my patients vestibular therapists because I'm like, for habituation, you can't avoid. So like, I can't give you necessarily an exercise that I want you to do over and over and over again. I want you to stop avoiding this, but then stop avoiding it within this available, you know, acceptable symptomatic range so that we're not, you know, going overboard.
And if it's gaze stabilization, okay, what, there's a lot of different types and ways to do gaze stabilization. You know, the three main ones I think that most people probably go to are times one, VOR cancellation, and eye on head between two targets. At least those are my, you know, three go-tos.
And so I'll teach patients whichever one I think is best for them. And sometimes it's on the, how well their VOR is working. And sometimes it's on what direction or what type of exercise out of those three is most provocative. If it's someone who's really symptomatic, then I'm probably going to go eye on head between two targets because it doesn't force like that visual fusion. And it's just easier for patients to work in their lateral visual zones.
And so I tell them why they're doing it. And then I give it, I try and make them incorporate those things into their everyday life because I don't want to give them a 30-minute program that they're going to go home and do for 30 minutes straight. They're going to be miserable. And it's not great to just build, build, build, build.
I need like that symptom recovery. And so when I'm giving these type of exercises to patients, I try and really get a sense for what their day is. What is a normal day for you?
And how can I add in these principles into what you're already doing? So if you're sitting at the desk at... work and you know you look up do you have a plaque on your wall that has letters on it find a letter focus on it I teach them the importance of having like a true target to focus on don't just make it like this oblique object it needs to be a crisp clear target needs to be smaller not larger and you should be able to see it when your head is still and if that's the case there's your exercise do that for 30 seconds and then take a deep breath and go back into doing what you're doing. If they're at home, instead of one Post-it note, I probably send them home with like 10. And I'm like, put one on your bathroom mirror. Put one on your refrigerator.
Every time you go to the bathroom and wash your hands. Every time you open up the door, just do 30 seconds. It's a reminder because you pass it.
It's more likely to get done because it doesn't take 20 minute block out of your day. I just really try and incorporate it into what they're doing every day. So that it's one, more likely to get done, but two, it's more practical because then they can space it out and allow their brain that recovery in between repetitions and exposure.
Those are really, really great tips and something that, you know, just over the years you find what tends to be more successful for patients. So one, getting that patient buy-in. I can't tell you how many times patients come in and they, oh, I've done this before, but I don't know why we have to do that. Like, what does it even do? Yeah.
So if they don't know why they're doing it, then why the heck would they buy into doing it regularly a couple of times a day consistently for a long time? Right. And then if you can work that into their daily routine, they're more likely to do it.
They're going to be consistent. They're going to start seeing results, making your job a heck of a lot easier each time they come back. Yeah. Yeah. I mean, those are extremely, extremely, really good points.
And it's something that makes it very unique for every patient, just the way that this therapy should be. So I love that. Hey guys, it's Abby here.
Unclench your jaw, relax your shoulders, take a nice deep breath. Doesn't that feel better? Thank you so much for listening to Talk Dizzy to Me.
One of our missions here at Balancing Act Rehab is to spread awareness about vestibular dysfunction. And the best way to do that is with your help. We'd be so grateful if you took a moment to subscribe, review, and share our show with someone you think would benefit from hearing our conversations.
Let's get back to it. You know, we talked about some equipment like our post-it notes, those, you know, really sophisticated expenses. What other are your go-tos? What are your must-have, your favorite things that you like having in your clinic, in your new clinic, especially, that you need to have with working with patients? Yeah.
So from a treatment standpoint, I keep it simple. So I think trying to make it fun, I do like a lot of floor dots so that there's lots of targets. I have like lots of different card games on the walls, spot it. I think a lot of vestibular therapists love spot it. We love that.
Even just my family, we have all the different like Marvel and different types. We love spot it. My patients like it like the first two sessions and then I get those cards out and they're like, oh, no.
But there's lots of different sets. I have like a camping set and a Halloween set. It also is a really good screen for cognitive function because I'm surprised at how many patients take longer than I think they should to really find those targets. But anyway, so spot it. You can put them in different planes.
I do a lot of like. fun laser games. So I have like the head laser for when I'm doing cervical training and stuff. So I'll just use that in my hand and I'll like walk on the treadmill, find the laser.
You know, they're trying to look around the room and find where the laser is on the wall. I have stuff like around my clinics. I'm like, okay, count the number of pictures on the wall or like anything that's, you know, in their visual environment that's going to encourage head movement.
They're, um, The international conference last year, they talked about sometimes maybe treadmill dynamic visual acuity is actually really beneficial versus just doing times one viewing. So I have like fun jokes printed out in different colors and different font sizes that I can put on the treadmill. So as they're walking, they're trying to stabilize their gaze, reading the jokes.
They think some are funny, some are not. Just whatever I could find online. Boxing is. really, really nice for vestibular. I do a lot of Parkinson's patients. So I have a lot of Parkinson's equipment in the clinic and I find boxing really beneficial for multiple reasons.
So I can change the target zones, whether they're looking up or down or around based on where I put the mitts that they're trying to hit. But also these patients, like they need one aerobic. activity. And this gives them that without having to bounce on the treadmill or anything like that with their head too much, like you would if you were jogging. And boxing can be very aerobic, but it's also therapeutic because you get to hit something.
Right? It's amazing. Right?
And I mean, having a vestibular dysfunction can be frustrating. And like, sometimes they just need to hit something. You're not wrong. I think a lot of people would feel a whole lot better if they can just get their anger out a little bit at the end of the day.
That sounds like a great idea. Yeah. You know, I see a lot of patients that I call them lazy vestibular systems.
There's not necessarily a diagnosis. I think people who have lingering vestibular migraine in between migraines get lazy vestibular systems where they just need to like turn them on. And sometimes that might be gay stabilization, but sometimes that might be yoga or boxing or, you know. I recycle the power moves for Parkinson's for vestibular exercises.
Instead of just like having them move their arms and trunk, I really force head movement during them. The quadruped ones and the standing power moves are really, really good for that. And just waking things up a little bit.
And that's more tolerable than trying to look at a target and move your head back and forth all the time. And our vestibular systems weren't made to just work in the horizontal plane. I try and get all my vestibular patients, at least on the ground and off the ground, for some of their exercises to really work on the multiplanar sensitivities. They've probably avoided that for a long time, and they just need to show their brain they can do it again.
And that's surprising. the number of patients who actually leave a vestibular therapy session feeling better versus feeling worse. And those are the patients I know are like, okay, you just have a lazy system. We need to turn it on every day. So at home, do this just to turn it on in the morning.
Those are amazing recommendations. And if you guys were listening closely, you realize that everything that you just listed was make well at home or very inexpensive. You don't need a lot of the fancy. equipment to be successful with these patients and to get a lot of difference in the different type of approach to therapy and variability in what you're doing with them, which is absolutely amazing. I mean, I love the laser idea on the treadmill.
I love the jokes that are printed out. Boxing itself is just absolutely, that's a really, really great recommendation. You can get a set of gloves and the pads to hit on Amazon, which are not too expensive.
I mean, I love it. I love it so much. Now, do you have any...
favorite exercises that you've created for a patient that was doing something unique, or they were trying to get back to functional specific to them. Anything in particular that stands out or comes to mind? Because sometimes they can get really crazy. You know, up in Hilton Head, we had a lot of golfing.
So I had a lot of patients on, we would simulate bunkers or hills and standing on foam and swinging a golf club or picking up dog poop for walking dogs. Um, but it can get, it can get pretty fun. Is there anything that stands out to you?
Um, I mean, a lot of times I, I'll see like factory workers who have to do like an assembly line. And if you've ever worked on an assembly line, I mean, you're up, down, you're turning, you're rotating, you're trying to concentrate and it's fast. And so, you know, I've had some pretty creative setups in the clinic that mimic an industrial assembly line on, you know, I have a 45 pound lifting.
Um, need at work. And so, okay, I need the heavy weights. I need to do it in the diagonal plane up to the right bend over. I'm going to do this on foam so I can really challenge the vestibular system. Um, but I'm going to start by having them fatigue themselves on the treadmill because a 12 hour shift is long.
So let's fatigue them out. Now try and do your work demands like the end of your shift. Um, and that's, you know, everyone always talks about how creative some of my posts are, but It's really my patients making up a lot of that setup because the first thing I ask them is what was challenging or what are your concerns?
And then I just recreate their lives in my clinic to try and get them to habituate to whatever it is they need to get back to doing. That's so great. I mean, really, it comes down to the individualized patient centered approach. Yes.
It's fun, right? Like if I had to do the same thing with every patient every day. That's makes for a long day. Yeah.
If it's boring for the patient in like the one minute they have to do a VOR, imagine doing that for like 10 patients in that day. It's just, it gets to be too much at some time. Yeah, definitely. Now you had mentioned, you know, those lazy vestibular systems, but there's also vestibular therapy that we do for the non-dizzy patient.
Can you talk a little bit about that and the course that you've developed for that? Yes. I love talking about that. So this really stems back from my...
time at Neuro Rehab and Balance Center where I spent the first, you know, year, what we do, what, you know, I was used to in my clinic was, okay, you first as a new therapist get comfortable treating balance because they're the easiest. And then once you're comfortable with balance, let's add in stroke and brain injury and Parkinson's and MS. And then when you're comfortable with the neurologic patients across the spectrum, now we'll add in vestibular. So then we'll send you to Emory or whatever, you know, we have patients or therapists do like the Jeff Walters courses.
And then you can start to work on vestibular rehab. And I think that that's probably common in a lot of settings. It's just like an afterthought. But then once I did vestibular rehab, I was like, every single patient I've seen in the last two years needed vestibular rehab.
And I didn't do it. And. And the general population is, okay, dizzy patients need vestibular rehab.
And we all know that. But there's a lot of non-dizzy patients that also need vestibular rehab. If you're treating balance, you're a vestibular therapist. It's the balance organ.
You can't separate it. MS patients, there's a lot of research coming out on the benefits of MS patients going through bouts of vestibular rehab every once in a while. Parkinson's patients have been shown to really benefit from vestibular rehab.
Any type of cerebellar or brainstem stroke needs vestibular rehab. But then you have this like whole other caveat over there of like geriatric patients and aging, high fall risk. And that is vestibular therapy. And a lot of them aren't actually dizzy. And before I left my other clinic, I actually did a research study on this because since I had the vestibular brain and I was also seeing just general balance patients, I was able to really pick out like, oh, this is a vestibular balance problem.
And I could do the BPPV screening. And I was really surprised at how much BPPV I was finding in patients who had no report of dizziness. And I was like, we've got to study this. So we, for two years throughout. a pandemic, we actually ran a research study where we took all of the balance patients that came into the clinic who had no report of dizziness in their history.
And we tested them for BPPV. And this is actually going to be a poster at CSM in February, but it's 25% of balance patients without any report of dizziness from their primary care provider had BPPV. Isn't that mind blowing? There's another study that's being run right now.
And they're finding very similar, very scary, not scary, not very scary. It's actually believable, but very close numbers to what you were just reporting on. And it's mind blowing.
So we've taken that 10% that was initially found in earlier studies. And it's actually a lot more common than we think, just because we weren't looking for it and people that weren't complaining about it. Right. It's crazy.
And then the barrier is, okay, how do we get PTs to feel more comfortable who are treating general population, balanced dysfunction, geriatric populations, home health, skilled nursing facilities? How do we get them to feel comfortable treating and testing for BPPV on the regular? It can't be an afterthought.
It needs to just be part of your geriatric evaluation. And through my adventures of, you know, my history, I feel like... a lot of the courses out there in vestibular are advanced or you can't like put your toe into vestibular, right? Like you need a lot of information. And so starting out your 20 hours of CEUs and just to start, you know, I probably completed over a hundred.
I don't even know how many. And so I was like to just treat a balanced patient who is in the geriatric category. What does an eval look like for them?
And yes, it'd be great if all PTs understood everything about vestibular. That would be a happy world, right? But that's not practical.
And so what do they need to still be effective at understanding the vestibular system? And that really goes back to what we do as PTs, which is a functional evaluation. So how do you look at VOR? How do you look at sensory integration? How do you test for BPPV?
The testing for it's fairly easy. And I think what has thrown my students off in the past from other courses they've taken is how many ways is there to treat BPPV? Like 30?
I don't know. There's so many different ways. It's a little overwhelming. Yeah. And everyone's like, do I go right?
Do I go left? Do I go up? Do I go down?
I don't know. But when you look at it, you know, the research is showing that like 90% of BPPV is the posterior canal, which is really not too... terribly challenging to treat. And so the course really stemmed from a home health and skilled nursing company that came to me and was like, how do we get our therapists comfortable doing just general vestibular balance screens and treatments in this population when they're in their home or they're in skilled nursing facilities that don't have vestibular equipment? And so I created the course for them originally.
And then it was an inpatient rehab reached out and was like, how do we do this in inpatient rehab? And I'm like, Like this is a huge need is like an easy to digest course that would teach general practitioners what they absolutely need to know to do. You know, honestly, a good chunk of what we do every day is vestibular therapists. You know, as specialists, we can talk all day about the intricacies of vestibular migraine and and, you know, how challenging that can be. And but it doesn't have to be all of that to be.
honestly pretty effective. And then know where your specialists are if people aren't responding to, you know, that basic vestibular program. Exactly.
If anything, because, you know, I think a lot of people's first initial reaction is like, oh, you're training your competition? And I say, no, you are, you are making more of you because there's only one of you to begin with, but you're making people more. Yeah.
It's, it's such a high demand, but you're making more people aware they're screening, they're helping more patients. And, you know, if they do feel like they're in over their head, that's when we know that they need to get to somebody who is a specialist. A lot of times you can do an Epley maneuver.
I mean, look at the Epley maneuver videos on YouTube. So many people will just their doctors tell them, oh, it's just crystals. Google this when you get home and try the maneuver.
You know, like it's it's a really, really sad fact about that. But, you know. There's a study that shows that 50% of people can 50% of the time fix their dizziness by following something on YouTube if they have a good video.
So we need to get more training out there, more screening. I think what you've created is amazing. We're going to make sure we link that in the show notes so people have direct access to getting to that and learning from all of your wisdom when it comes to that because it needs to get out there.
People really do need to take that in and learn how to help more people and help us help more people. Yes. Now, something that we've touched on, and I really want to make sure we hammer this home because we get a lot of questions about this for the podcast, is the importance of mentorship and getting in more learning in Con Ed.
So could you talk a little bit about more in depth some of these programs? So you spent some time at UPMC with Sue Whitney. What was that like in comparison to Emory?
Did you do Emory first? Did you work with Sue first? What did that look like? Um, so I knew I was going to be... going down this vestibular road as soon as I was hired because I was told.
So I was starting to like shadow other vestibular therapists in the clinic in preparation for my first continuing education course, which was Emory, which is a week long course. It's about probably as intensive as you can get to start out. You don't want to go if you've never treated vestibular before.
You should have a couple of like weekend courses under your belt. You should have at least a year. of working with vestibular patients before you attempt this.
It is live, breathe, eat, you know, everything. They put you up in the conference where the conference hotel, where your conference is. You have these sessions, you have like end of the day lab practicals where my first lab practical was with Susan Herdman and I fangirled and almost fainted.
I had to do an FGA for her. And I was like, Oh my God. Yes. Yeah.
Oh, I had, I had everybody signed my book, like a big vestibuloholic nerd. Like it was great. But yes, you don't want to go without any experience. But I do think that's a really, really great jumping off point for the person who wants to seriously specialize in vestibular rehab.
That is like your foundational, you must pass this. You have to sit for a written and a video board at the end of the week, as well as pass all of your lab practicals at the end of each day. And hence, it's very popular by demand and fills up very quickly.
When do they usually open up? the registration for that. Is that usually early, like January, February? Yes.
But I know last time I looked, there was like a two-year wait list because they were already like a one-year wait list and then it got backlogged for COVID. So they lost like a whole year. So look into that if you're thinking. Planning ahead is important.
So after Emory and after you got bitten by that bug, this was something that you want to keep pursuing. Where did you go next? So next I went to University of Pittsburgh Medical Center to do the advanced course with Sue Whitney's group. And that is like a three-day course, I believe. And they start to integrate some of the concussion training.
So it was, you know, a day and a half of advanced vestibular, maybe going over some more advanced maneuvers, extra things you can look at. They talked about like, you know, the V-hit at the time was new. It's not new anymore. And then you do like a whole day on concussion because that's a very large crossover into the world of vestibular.
therapy. And then, you know, when I went to Emory, the clinic I was in was growing so fast and had such a high vestibular demand that I was fortunate to go with five colleagues. I was one of five.
And I was coming from a clinic that already had, you know, probably four or five therapists who had already been at Emory and were already treating a very heavy vestibular caseload. And so when you leave a conference or a course like that, where you have six days of intense information, you come back and you're like, okay, here's the patient in front of me. How do I take all of this and apply it to this patient?
And then every patient is so different. And so you get this question or this question. And there was something about being able to leave that treatment room, go down the hall and ask my mentor, what do I do about this?
That just accelerates your learning. it made every patient I saw that much more helpful to me to build this puzzle because they're all big pieces. You get lots of pearls and pieces.
And how does that all fit together for this patient? And then those same pieces might fit together differently for this patient. And so having people who are used to vestibular to tell me, don't worry so much about that for this kind of diagnosis. Or, yes, I know your your eval is. showing you these abnormal findings, but look at the big picture, you know, smooth pursuit.
And a 20-year-old better be normal, but smooth pursuit. And an 80-year-old might just be abnormal because of their history. And so where do you weight normal, abnormal?
And how does this picture look in your evaluation? And then once you feel somewhat confident about your evaluation, now what do I do with it? And then just like you see on Instagram, we all feed on different treatment ideas. But being able to see 11 other vestibular therapists in one big gym, what are they doing for that patient?
And what's their idea? And it was just like a think tank, I think for vestibular rehab and having those people around me gave me so much confidence and a skillset that I couldn't get. I don't think from just going to a course.
Well, that mentorship is so important. I mean, I've been out of school and treating vestibular patients now for going on 10 years, and I still have to call up Jeff Walter sometimes and say, What is going on here? What am I missing? And he'll like point one little thing out and it's like light bulb, duh.
But sometimes you need that. I mean, I was fortunate when I went to the Emory course, I didn't go with anybody in particular, but I found an old classmate from PT school and my PT school neuro teacher were both there in attendance. And thank God I had them because if you miss something in one of the talks, you want to be able to bounce it off somebody else and get somebody else's notes and just confirm what's going on because it really will leave you spinning. And then to get back to your clinic and to have somebody to be able to talk to and work through what your evaluations look like, what your treatments look like, you know, should you be looking at things a little bit differently is hugely, hugely helpful. I'm sure that a lot of people listening, there are a good chunk of them who maybe they're the only PT in the clinic who haphazardly volunteered to go take a BPPV course in a weekend.
And they are now they're like vestibular. pro for them. And they are probably just overwhelmed.
Like once you dip your toe in and you kind of get in the water, you get a little wet, you realize how deep that well is. And you're like, Oh, crap. So having, you know, people search people like you out on Instagram, you know, they, there is so much more today, in terms of resources for clinicians getting into vestibular therapy, that it's amazing, like you need to take advantage of everything that you can, all the knowledge that you can, because what we have on social media and YouTube and courses for people like you who are putting their information out there for other clinicians to learn from are invaluable.
So that is absolutely amazing. Some of those other courses, like Jeff Walter has a series on MedBridge. So does Sue Whitney and Laura Morris and Ann Muka.
There's so much out there now that didn't exist 10 years ago, I'll tell you that much. Right. So to key into that's huge.
And even though I... I knew a lot of that stuff when I watched those med bridges. It was access. So, you know, you just want to hear like, what's different? What's the same?
And they're really good courses. I mean, for being an online platform that was newer a couple of years ago, how much can you really learn from that platform? But it's very effective.
And, you know, with such a long wait list at other courses, we've actually somewhat transitioned into, OK, let's start here. This is a great foundation. Also just getting together with other vestibuloholics, you know, when Abby and I started Talk Dizzy to Me during right the beginning of the pandemic, it was more of just a way for an excuse to us to like pick the brains of people in the vestibular world.
I mean, we've had Neil Shepard on, we've had Dr. Tashido on, we just had Dr. Kurthuis on and that episode will appear or maybe has already been published when this one comes out. But like, I mean, we talked to the guy that invented the headrest test. Like, wow.
cool is that? You know, even just a conversation with Dr. Tesho, there's these light bulb moments of how we can rephrase things to educate our patients. And then meeting with other physical therapists and vestibuloholics at ICVR, at the International Conference for Vestibular Rehab, or CSM, it's constantly a learning experience.
And there's always something new to learn. There's always new research coming out, you know, which is something that we need to just keep continually digesting. Yeah. I think it's, it's just, it makes it so much fun and so exciting to be in this field. Yes.
It's a small world, but it's a good world. Small but mighty, just like our vestibular system. We're making it a bigger world. I do want to point out, so I'm going to put your Instagram handle on here, the vestibular underscore neuro underscore PT for those listening. You need to go check out Christina Garrity and check out what she's doing.
If you are a patient in the Ohio area, please check out her website too. Um, that's labyrinthpt.com. Um, you are just a wealth of knowledge. I am so excited that we had you on today and thank you so much for agreeing to be here.
I have a feeling like Abby, Abby missed out this episode. So we're going to have to bring you back and pick your brain a little bit more and talk maybe some more treatment approach, because I think some of our clinician listeners might appreciate that. So thank you so much for coming today. Is there anything else? Um, anything else that we can put out there for people to find you or anything else that I didn't hit on quite yet.
No, I, you know, it's funny, I started that Instagram as like an outlet from teaching, because I stepped away from teaching when I started my PhD. And I was like, I still have, I still want to teach. And so it's so great how social media platforms have really changed the way we learn because people want good information, but they want it easy to digest, and they want it quickly, and they want it when they want it. And so just social media in general has really, I think, changed the way that we learn and the way that we practice for a good way and a good way. So thanks for sharing those.
Appreciate it. No, thank you so much. And for all you guys listening, make sure you check her out and we'll talk to you guys again soon.
Thank you. This podcast is provided for informational purposes only, and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition.
The content of this podcast is based on general knowledge and information available up until the recording of this specific episode. Medical knowledge and practices may evolve over time and new information may emerge that could change the understanding or treatment of vestibular dysfunction. It is important to consult a qualified healthcare professional for the most up-to-date and personalized advice. The information provided in this podcast is meant to complement, not replace, the relationship that exists between a patient and their healthcare provider.
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