1/6. Remote medical consultation for vestibular disorders: technological solutions and case report.Complaints of vertigo and imbalance are common presentations to primary care physicians, yet there are few specialists who diagnose and treat these problems as a significant part of their practices. We demonstrated the feasibility of remote consultation for a patient presenting with vertigo using a two-way digital video and audio network. It was possible to take an appropriate history, examine the patient, and provide a diagnosis and treatment. The patient had a common problem that causes dizziness: benign positional vertigo (BPV). An essential component of the examination was the use of a head-mounted display with embedded cameras. The cameras allowed viewing of the patient's eye movements, which were diagnostic.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/6. The vestibular dysfunction and anxiety disorder interface: a descriptive study with special reference to the elderly.Vestibular abnormalities co-existing with anxiety disorders are not uncommon and there has been a renewal of interest in recent times. Although well known over centuries, there is often a delay in the recognition of this relationship by the primary care physician and the specialist alike. dizziness embracing vertigo, unsteadiness and imbalance are common in the elderly, so is generalized anxiety disorder, which is a common psychiatric problem in later life. This is a retrospective study of eight patients with vestibular symptoms and an anxiety disorder present over several years with lack of awareness of their relationship. The diagnoses of the anxiety disorders were based on the Diagnostic and Statistical Manual (DSM-IV) criteria and the effect of treatment measured on a clinician-based impression interview. There was one male and seven females and the mean age was 72 years. Apart from the vestibular symptoms present in all the patients, the anxiety disorders comprised, generalized anxiety disorder in three, panic attacks in five and with agoraphobia in three. Four patients had hyperventilation, one sleep apnea, and two somatization disorders. They had all presented to clinicians in different disciplines and had had several investigations. Five had been treated in this study with alprazolam and three with citalopram, with modest to good results. Two had rehabilitation therapy as well. The cases described mirror the well-documented co-existence of vestibular and anxiety disorders together with hyperventilation and sleep apnea. The positive findings associated with vestibular dysfunction need recognition in addition to the non-specific psychiatric and behavioral symptoms. We emphasize this relationship and review the literature to alert the clinician.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/6. The team approach to treatment of the dizzy patient.This report describes how a rehabilitation team treats dizziness and vestibular disorders. Team members include a nurse, physician, audiologist, physical therapist, occupational therapist, and a research scientist. Although unusual, this multidisciplinary approach, involving a close-knit group of professionals, is of great benefit in the treatment of vestibular and balance disorders.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/6. Physical therapy program for vestibular rehabilitation.dizziness and balance disorders are among the most frustrating problems for many physicians to treat. Traditional interventions such as medication or surgical procedures offer limited improvement for many patients. Although generic habituation exercises have existed for years, the merits of vestibular rehabilitation are only beginning to be recognized. Current retrospective studies indicate that 85 percent of patients with chronic vestibular dysfunction gain at least partial relief of their symptoms after undergoing vestibular rehabilitation, with approximately 30 percent of patients being completely cured. This modality provides a valuable and rational complement to current established methods of treating the patient with dizziness. Many physicians and physical therapists may be unfamiliar with these new techniques and require clarification of the actual therapeutic approaches in use. This article describes the current evaluation and treatment approach utilized in the vestibular rehabilitation program at the University of michigan Medical Center.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
5/6. Vestibular rehabilitation with graded occupations.These three case reports are examples of the use of graded, purposeful activities in remediating the symptoms of vestibular disorders. Therapists can design individualized treatment plans for each patient by incorporating activities of interest to the patient. The treatment activities must include the particular head movements and positions that elicit vertigo during assessment. Additionally, activities must be interesting to the individual patient. Use of interesting activities may sustain the patient's interest and motivation for the treatment program and enable the patient to relate the learning process to real life experience. The principle that graded, repetitive head movement exercise is efficacious in reducing vertigo and disequilibrium in patients with vestibular disorders is now well accepted among physicians and therapists who treat these patients. The principle of adding meaning or purpose to otherwise rote exercise is well accepted among occupational therapists and is supported by evidence from the empirical literature (Heck, 1988; Kircher, 1984; Yoder, Nelson, & Smith, 1989). This concept of adding purpose to repetitive exercise may now be extended to the treatment of patients with peripheral vestibular disorders.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/6. Clinical manifestations of transdermal scopolamine addiction.Transdermal scopolamine patches have been extensively prescribed for nonspecific dizziness and vestibular disorders. Patient response may be favorable and side effects are generally limited to xerostomia and blurred vision. However, subtle dependency and outright addiction may develop. Tapered reduction and drug elimination will suffice to eliminate the dependency. However, hospitalization may be necessary to treat severe cases of physiological chemical dependency. Long-term use of transdermal scopolamine patches carries a risk of chemical dependency. Prescribing physicians should review and heed the manufacturer's recommended use.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |