August 3, 2018 at 11:31 am #73769
Why did you choose this article?
Differential diagnosis is one of my favourite aspects of vestibular rehabilitation (VR). It’s the closest we get as physiotherapists to ‘arm-chair medicine’. I enjoy the challenges of the master diagnostician role. That said, I appreciate the it can be a challenging aspect of VR and I was interested to see how this team approached the task. A good diagnosis is an important first step in provided a good treatment plan.
What is the question being asked?
This article aims to provide clinicians with a systematic approach to accurately diagnosis cervicogenic dizziness (CGD), an area of practice that is notorious for being a diagnostic challenge.
Describe the content of the paper, and some take-home messages.
This position paper is designed for clinicals who see patients with potential CGD. This would include sport and ortho/manual therapists. It would also be relevant to neuro and spine therapists who see patients after trauma (such as a traumatic brain injury or spinal cord injury after a motor vehicle accident). Many physicians, such as Physiatrists and Sports Medicine doctors, would also be interested in this type of review paper.
In some ways this article reads more like a book chapter than a review article. It systematically lays out diagnosis of CGD as a 5-part process. The most relevant or current publications were cited.
Can you comment on the validity of the study?
In general, I feel this article nicely summarises how I approach CGD assessment. The usual ‘key’ issues are all there (such as comments around the temporal relationship between neck pain and dizziness; the importance of a good history; the definition of vertigo; etc.), it includes a review of key differential diagnoses, and there is a good overview of the currently used guidelines and clinical tests (including test description and review of literature, such as sensitivity and specificity).
I also appreciate the acknowledgement that some patients will have more than one diagnosis, such as symptom contribution from WAD, concussion, and CGD. I also agree with the approach of checking safety issues first (e.g. vascular blood flow and C-spine stability) followed by a neuro screen prior to conducting a vestibular assessment. This is a good reminder as there is such a push to ‘see more patients in less time’ … it points to the value of a thorough assessment as opposed to simply jumping right into a vestibular assessment.
How do the results relate to current practice or influence future practice?
This review article is valuable to any physiotherapist who treats patients with dizziness after trauma. Clinicians may find it helpful as a resource (e.g. if they would like a reminder on how a particular test is performed) or to ensure their current vestibular assessment form includes the tests and process in this framework. Despite the challenges of this task, this framework is a clinician’s best bet at unpacking the complicated assessment of the post-traumatic dizzy patient.
Some clinicians may need to refer to the references for more test details, or they could also refer to a textbook (such as Vestibular Rehabilitation by Susan Herdman, (2014 edition).
PhD, BSc P.T., BA, Member CPA
Clinical Specialist, Neurosciences