fast-track assessment, screening & treatment pathway for … · 2010. 5. 28. · dizziness...

Fast-track Assessment,

Screening &Treatment pathway for

Enhanced vestibular Rehabilitation

United Christian Hospital(Audiology, ENT & Physiotherapy Departments)

Presented by Ms. Becky Lam (PT)

Uncompensated PeripheralVestibular Hypofunction

Activity level

Functional independence

Social interaction

QOL

Dizziness Vertigo

OscillopsiaDysequilibrium

Conventional ModelGP/ GOPC consultation: refer ENT

1st ENT specialist consultation

Vestibular diagnostic Ax by audiologist (ENG)

ENT Fu with vestibulo-suppressant prescription

Allow time for self compensation

~ 6 months

~ 16 months

Long Waiting Time

No Way Out

Health CareHealth CareSystemSystem

Dragging in Health Care SystemDragging in Health Care System

FASTER – The Solution

Preliminary VNGAx by PT

GP/ GOPC consultation: refer ENT

1st ENT specialist consultation

Advanced vestibular diagnostic Ax

Physiotherapy Vestibular Rehabilitation

New Triage System

New Triage System

1st ENT consultation:6 months 1 month

ENT specialists triage patients with possible vestibular hypofunction from routine waiting list

Advanced Vestibular Diagnostic AxVideonystagmography (VNG) by Physiotherapist

Diagnostic test: 16 months 2 monthsVestibular Rehab for indicated cases

Physiotherapy Vestibular Rehabilitation

Comprehensive Assessment– Vestibular symptoms– Functional limitation– QOL

– Oculomotor function– Balance

Specific & individualized training

Physiotherapy Vestibular Rehabilitation

• Adaptation, Gaze Stabilization, & Substitution

Adaptation: Optokinetic Taining

Gaze stabilization: Focus, Head Turn

Substitution : Trampoline Walk

Physiotherapy Vestibular Rehabilitation

• Balance Training & Reconditioning

Balance Training:

Tandam walk, Balance Beam

Reconditioning KT II , Semi Lunge

GP/ GOPC consultation: refer ENT

Advanced 1st ENT consultation with triage system

Advanced VNG Ax by PT

Physiotherapy Vestibular Rehabilitation

GP/ GOPC consultation: refer ENT

1st ENT specialist consultation

ENG by audiologist

ENT Fu for medication

Allow time for self compensation

~ 1 month~ 6 month

~ 2 months~ 16 months

Conventional Vs FASTER

Time to obtain a confirmed Dx of vestibular hypofunction

6 + 16 =22 months

1 + 2 =3 months

March 2009 to March 2010

No of Patient 46

Mean Age 56 years old

Duration of symptoms 63.6 months (~ 5 yrs)

No. of PT session 5.2

Results of Physiotherapy Vestibular Rehabilitation

Outcome MeasuresSignificant positive effects were

shown in all 4 outcome measuresVisual Analogue Scale (VAS)

4.1478

1.4761

0

1

2

3

4

5

Pre-intervention Post-intervention

VA

S S

core

Dizzinesss Handicap Inventory Score

41.0667

24.8182

0

10

20

30

40

50

Pre-intervention Post-intervention

Tot

al S

core

Avarge Single Leg Stand Duration

26.534920.6279

0

5

10

15

20

25

30

Pre-intervention Post-intervention

Dur

atio

n (s

econ

ds)

*P < .000 *P < .000

*P < .000*P < .000

Numeric Global Rating of Change Scale

(NGRCS)

6.3913

00

2

4

6

8

Pre-intervention Post-intervention

NG

RC

S S

core

*P < .000

Outcome MeasuresNumeric Global Rating of Change Scale (NGRCS)

- Overall improvement with RxVisual Analogue Scale (VAS)

4.1478

1.4761

0

1

2

3

4

5

Pre-intervention Post-intervention

VA

S S

core

*P < .000

Avarge Single Leg Stand Duration

26.534920.6279

0

5

10

15

20

25

30

Pre-intervention Post-intervention

Dur

atio

n (s

econ

ds)

*P < .000

Dizzinesss Handicap Inventory Score

41.0667

24.8182

0

10

20

30

40

50

Pre-intervention Post-intervention

Tot

al S

core

*P < .000

*P < .000

Numeric Global Rating of Change Scale

(NGRCS)

6.3913

00

2

4

6

8

Pre-intervention Post-intervention

NG

RC

S S

core

*P < .000

Outcome MeasuresVisual Analogue Scale

- Symptoms severity measurementVisual Analogue Scale (VAS)

4.1478

1.4761

0

1

2

3

4

5

Pre-intervention Post-intervention

VA

S S

core

*P < .000

Avarge Single Leg Stand Duration

26.534920.6279

0

5

10

15

20

25

30

Pre-intervention Post-intervention

Dur

atio

n (s

econ

ds)

*P < .000

Dizzinesss Handicap Inventory Score

41.0667

24.8182

0

10

20

30

40

50

Pre-intervention Post-intervention

Tot

al S

core

*P < .000

*P < .000

Numeric Global Rating of Change Scale

(NGRCS)

6.3913

00

2

4

6

8

Pre-intervention Post-intervention

NG

RC

S S

core

*P < .000

Outcome MeasuresChinese Version of Dizziness Handicap Inventory- QOL (chronic dizziness) measurement

- High total score indicate fall risk

Avarge Single Leg Stand Duration

26.534920.6279

0

5

10

15

20

25

30

Pre-intervention Post-intervention

Dur

atio

n (s

econ

ds)

*P < .000

Dizzinesss Handicap Inventory Score

41.0667

24.8182

0

10

20

30

40

50

Pre-intervention Post-intervention

Tot

al S

core

*P < .000

Visual Analogue Scale (VAS)

4.1478

1.4761

0

1

2

3

4

5

Pre-intervention Post-intervention

VA

S S

core

*P < .000 *P < .000

Numeric Global Rating of Change Scale

(NGRCS)

6.3913

00

2

4

6

8

Pre-intervention Post-intervention

NG

RC

S S

core

*P < .000

Outcome MeasuresAverage Single Leg Stand Duration

- Balance ability measurement (Max. 30s)

Avarge Single Leg Stand Duration

26.534920.6279

0

5

10

15

20

25

30

Pre-intervention Post-intervention

Dur

atio

n (s

econ

ds)

*P < .000

Dizzinesss Handicap Inventory Score

41.0667

24.8182

0

10

20

30

40

50

Pre-intervention Post-intervention

Tot

al S

core

*P < .000

Visual Analogue Scale (VAS)

4.1478

1.4761

0

1

2

3

4

5

Pre-intervention Post-intervention

VA

S S

core

*P < .000 *P < .000

Numeric Global Rating of Change Scale

(NGRCS)

6.3913

00

2

4

6

8

Pre-intervention Post-intervention

NG

RC

S S

core

*P < .000

Amazing Change with FASTER

Long Waiting TimeENT SOPD (6/12)

Diagnostic Ax (16/12)

Symptomatic Control Only

SOPD Fu

Shorten Waiting TimeAdvanced ENT SOPD (1/12)

Advanced Diagnostic Ax (2/12)

PT Vestibular Rehabilitationto Enhance Physical Recovery

& QOL

Facilitate Dischargefrom ENT SOPD

Harriet Lo

Betty Tsui

Becky Lam

Dr. Luk

Mrs. E Chan

Yvonne Lam

Dr. Wendy Kwan

ENT Department– Dr. Victor Abdullah (COS)– Dr. Wendy Kwan (AC)– Dr. Alex Lee (Specialist)

Audiology Department– Ms. Betty Tsui (DM)

Physiotherapy Department– Mrs. Eleanor Chan (DM)– Ms. Harriet Lo (SPT)

Acknowledgements