Announcing VeDA Travel Grant Recipient

VeDA Travel Grant Recipient 2023

VeDA is partnering with professional associations to recognize research that advances clinical outcomes for vestibular patients through our Travel Awards. Winners receive $1,000 to put toward travel expenses to present their paper at a professional conference.

The winner of this year’s travel award in collaboration with the Academy of Neurologic Physical Therapy is Eric Anson, PT, PhD, for his paper on the Transient Postural Effects after Vestibulo-Ocular Reflex Gain-Down Adaptation in Healthy Adults.

Below is the winning abstract Transient Postural Effects after Vestibulo-Ocular Reflex Gain-Down Adaptation in Healthy Adults and the runner up Impact of Vestibular Examination Training in the Emergency Department submitted by Mark David Stephens, PT, DPT.

Transient Postural Effects after Vestibulo-Ocular Reflex Gain-Down Adaptation in Healthy Adults

Cesar Arduino, Michael C Schubert, PT, PhD, FAPTA and Eric R. Anson, PT, PhD


Purpose/Hypothesis: Balance is a multisensory process influenced by contextually dependent weighting of vision, vestibular, and somatosensory inputs. Reduction in vestibular function (i.e. vestibular neuritis) often acutely leads to increased sway. Otolith signaling is considered a primary vestibular cue for balance. Recent non-causal studies reported associations between lateral semicircular canal function and balance ability, but the direct link remains controversial. Here we investigate the immediate effect on body sway during a demanding vestibular task (foam eyes closed) following unilateral vestibulo-ocular reflex (VOR) gain down adaptation to simulate a mild semicircular canal only peripheral vestibular hypofunction.

Number of Subjects: 10

Materials and Methods: Healthy adults (seven female), mean age 28.4 (± 14.5), stood wearing an inertial measurement device (Opal, APDM Inc.) with their eyes closed on a foam cushion (Airex, Inc) before and after incremental VOR gain down adaptation (iGainDown) training to simulate mild unilateral vestibular neuritis. Three 30 second repetitions of sway area were recorded before and immediately after iGainDown. Active head impulse VOR gain was measured (EyeSeeCam, Micromedical, Inc) before and after iGainDown to ensure VOR gain reduced. Percentage change for VOR gain and sway area were determined. Three levels of sway area were defined for analysis: average sway area for the first 3 pre-tests (PRE), sway area for the first post-test (POST1), and average sway area for the last 2 post-tests (Post2). Change in sway area was compared (PRE-POST1, POST1-POST2, PRE-POST2) with 1000 bootstrap replications with replacement with significance determined confidence intervals derived with the percentile t-test. Population variation was simulated by adding noise up to 2 standard deviations with 1000 bootstrap replications with replacement with significance determined by percentile t-test.

Results: VOR gain decreased unilaterally exceeding meaningful change values for all subjects (average = -11.2%, range [-6 – 15%]). Sway area was significantly greater immediately for POST1 compared to either PRE or POST2 (average 87%, range [8 – 183%], p < 0.025). POST2 sway area was minimally, but significantly smaller than PRE (p < 0.025). The significance of the PRE to POST1 and POST1 to POST2 comparisons remained significant after allowing for additional within subject sway area variance simulating 2 SD of increased sway area, indicating a robust effect.

Conclusions: This is the first report of a direct link between increased body sway and reduced semicircular canal function as quantified by VOR gain in healthy adults. Rapid recovery of body sway suggests sensory reweighting away from vestibular cues to resolve the transient increase in body sway.

Clinical Relevance: This simulation of transient, mild semicircular canal only peripheral vestibular hypofunction in healthy adults suggests a direct link between lateral semicircular canal signaling and body sway.


Impact of Vestibular Examination Training in the Emergency Department

Mark David Stephens, PT, DPT, Jennifer Clarke Terry, PT, Ashley Mwongela and Janene M. Holmberg, PT, DPT


Purpose/Hypothesis: The implementation of a vestibular examination provided by a PT in the ED has shown to better manage dizziness, ambulation, fall risk, and balance confidence through earlier introduction of Vestibular Rehabilitation (VR). The objective of this quality improvement project is to review pilot data after implementing Physical Therapist (PT) vestibular examinations at a single Emergency Department (ED). Specifically, to define characteristics of individuals presenting to the ED for dizziness, how often PT examinations are being completed, and quality of the PT vestibular examination.

Number of Subjects: 6,666

Materials and Methods: Training was initiated on 6/1/21. Data was extracted on 6,666 individuals from 3/11/21 to 5/1/23. Individuals were categorized based on the admitting CPT codes. The groups were General dizziness (GD), Aural involvement (AI) (changes in hearing, ear pain, or drainage from the ear), Migraine, BPPV, and Peripheral Vestibular dysfunction (PVD). Descriptive characteristics were gathered. Individual chart reviews were performed on anyone in the group who received a PT examination in the ED.

Results: During the 3-month period prior to the training no PT examinations in the ED were completed. The group were on average 67.3 years of age and 57.3% female. 4420 (66.3%) individuals were GD, 1730 (26.0%) AI, 230 (3.5%) Migraine, 180 (2.7%) BPPV, and 97 (1.46%) with PVD. From the entire group only 157 (2.36%) were assessed in ED by PT and 1 was assessed by SLP. A total of 100 (2.26% of 4420) PT examinations occurred in the GD, 25 (1.45% of 1730) in the AI group, 1 (0.43 % of 230) for migraine, 17 (9.44% of 180) for BPPV, and 14 (14.4% of 97) in the PVD. Of the total 157 PT assessments, 98 (62.42%) included a patient description of their dizziness, 85 (54.14%) completed VOR assessment, 99 (63.065) completed an oculomotor screen, 87 (55.41%) performed positional testing, 80 (50.96%) performed a neurological screen, 126 (80.25%) completed a gait and/or balance screen or assessment, 25 (15.92%) performed a BPPV intervention, 82 (52.23%) had a summation of findings leading to a diagnosis related to the ED visit, 72 (45.86%) documented education provided, and 146 (92.99%) made a recommendation for the next level of care.

Conclusions: Evidence supports there are increased individuals receiving PT vestibular examinations in the ED after the training. It is also evident they are not identifying all good candidates for PT vestibular examinations. Findings on the quality of the vestibular exam show some adherence to a complete exam, however there is a need for additional training.

Clinical Relevance: This preliminary data will serve as guidance for implementation of a standardized PT vestibular examination in the ED. This will improve accuracy of diagnosis, quality of care, length of stay, and decrease cost of care and unnecessary imaging. Given the insight from the chart review it is essential to train acute PT in vestibular examination to ensure the most current evidence-based care for this neglected population.