Can you review the CPG guidelines for frequency of treatment and define acute, subacute, and chronic?

Answer:

“Somebody who’s very acute, their symptoms are increased with just a little bit of head movement, is somebody who we would put in that acute stage. Subacute, they can start moving a little bit more. They’re not quite as nauseous with everything that they do, but they’re still… Head movement, they’re the ones that walk into our clinic and they’re moving very in blocks still. They don’t feel comfortable moving their head. But when they move their head, their symptoms aren’t quite as bad. So, the acute stage is where we’re going to start with and we want them to move throughout the day, preferably at least 12 minutes. We want them to be doing gaze stabilizations, preferably for at least 12 minutes. But we also want them to be doing other balance activities, as well, for about 30 minutes a day. So, it’s not only working on that gaze stability. The subacute, I said that.

And then the chronic people, those are going to be the people who, this has been going on for several months. Just like Dr. Whitney had said, we don’t usually get the opportunity to see the people who are acute because they do tend to get better on their own. But we tend to see the ones who have continued to have the problem. So, I would say oftentimes, we are seeing the more chronically involved patients. So, they still just don’t feel good when they do things and they’ve learned to avoid most of the things that cause them problems.

And so, in terms of that, we want them to be working on gaze stabilization exercises for about 20 minutes a day. And again, these are broken up into small pieces. If they can only tolerate 15 to 20 seconds at a time, then they do that, but we try and get them to do it at least two minutes up to five times a day, minimum. I mean, it’s three to five times a day is what they say. I usually shoot for five times a day and I tell them, “If you’re only doing it for two to four minutes at a time, five times a day, that’s not asking that much.” And I have them work on their balance exercises oftentimes while they’re doing it, so they’re kind of getting a twofer at that time.”

RESOURCES & LINKS:

  • This Q&A is an excerpt from the Vestibular Health Summit Sessions
  • The Vestibular Health Summit Sessions are included with 360NeuroGO Enterprise

FACULTY:

Michelle Gutierrez, PT, DSc

Bridgett Wallace, PT, DPT

Bridgett Wallace, PT, DPT, has a doctorate of physical therapy and holds competency-based certifications in vestibular rehabilitation and concussion management. Dr. Wallace has been treating patients with dizziness and balance disorders for more than 20 years and is the founder and President of 360 Balance & Dizziness – a specialty clinic for the evaluation and treatment of dizziness and balance disorders that includes both audiology and therapy services. She is also the co-founder and Director of Clinical Education for 360 Neuro Health Institute, which provides online, mobile, and live educational offerings for healthcare providers.