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Video 1

Challenge 1: Lesson 1

Vestibular A&P and Neural Compensation

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Watch the video, review the quiz questions, then log in to 360NeuroGO to complete Challenge 1!

We deep dive on anatomy and physiology: if we don't understand normal physiology, how can we possibly grasp pathology?

For anyone looking to excel in vestibular assessment and rehabilitation, understanding Vestibular Anatomy and Physiology and Vestibular Neurophysiology Compensation is crucial.

Quiz Questions: Test Your Knowledge:

1. The vestibular labyrinth contains 2 types of sensors, the semicircular canals (SCCs) and the otolith organs (utricle and saccule). Each of the 3 SCCs contains an enlarged area known as the _____________________ and are important for the transduction of neural activity while the otolith organs are important for the transduction of activity.
  • a. cupula; linear; angular
  • b. ampulla; angular; linear
  • c. ampulla; linear; angular
  • d. common crus; angular; linear
  • e. round window; linear; angular

2. Peripheral vestibular nystagmus is described by the fast phase as well as one of the following characteristics:
  • a. decreases when looking into the direction of the fast phase
  • b. horizontal and pendular in nature
  • c. decreases without fixation
  • d. decreases with visual fixation
  • e. increases with visual fixation

3. Which of the following types of nystagmus is considered pathological?
  • a. optokinetic, caloric and/or rotational induced
  • b. optokinetic and end-range
  • c. spontaneous and end-range
  • d. spontaneous, gaze-evoked, and/or positional
  • e. congenital

Video 1

Challenge 2: Lesson 2

The Value of Vestibular Diagnostics

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Vestibular diagnostics play a crucial role in assessing the function of peripheral and vestibular pathways. They assist in diagnosing vestibular dysfunction, offering valuable insights into the progression of diseases, and effectively monitoring recovery.

Quiz Questions: Test Your Knowledge:

1. A VNG can be helpful in measuring characteristics of nystagmus. What is the primary clinical utility (value) of a VNG?
  • a. Results lead to a specific diagnosis
  • b. Provides a measurement of the function of all semi-circular canals
  • c. Provides a measurement of otolithic function
  • d. Consistently produces positive (abnormal results) even in mild cases of peripheral system involvement
  • e. Results can guide medical and therapy management and can also identify a vestibular weakness

2. What is the clinical value of a Vestibular Evoked Myogenic Potential (VEMP) test in measuring the function of the superior and inferior vestibular nerve branches?
  • a. It assesses horizontal canal function.
  • b. It evaluates otolithic organ function and the respective nerve branches they innervate.
  • c. It measures auditory pathway integrity.
  • d. It tests visual reflex responses.
  • e. It determines cervical spine abnormalities.

3. What is the clinical value of the video Head Impulse Test (vHIT) in identifying overt and covert saccades, and how does it correlate with the demands of daily activities compared to caloric testing?
  • a. It measures low-frequency vestibular function relevant to quiet standing.
  • b. It assesses high-velocity vestibulo-ocular reflex (VOR) function which is more representative of everyday movements.
  • c. It evaluates auditory pathway integrity under quiet conditions.
  • d. It identifies central vestibular disorders through low-velocity stimuli.
  • e. It tests visual tracking abilities during slow head movements.

Watch the video, review the quiz questions, then log in to 360NeuroGO to complete Challenge 2!

Video 1

Challenge 4: Lesson 4

Peripheral Vestibular Disorders and Medical Management

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The “WHY” we delve into common and even less common vestibular disorders is apparent. Accurate diagnosis is the cornerstone of effective treatment, and understanding the pathophysiology and optimal medical management of vestibular-related disorders is key to improving patient outcomes.

Quiz Questions: Test Your Knowledge:

1. Which of the following best describes the diagnostic criteria for Vestibular Migraine?
  • a. To diagnose a vestibular migraine, there must be a current or previous history of migraine, and at least half of the dizziness or vertigo episodes must be accompanied by one or more of the following: headache, photo- and phonosensitivity, or visual aura.
  • b. To diagnose a vestibular migraine, there must be a current or previous history of migraine, and the dizziness or vertigo episodes must be accompanied by one or more of the following: headache, phonosensitivity, photosensitivity, or visual aura.
  • c. To diagnose a vestibular migraine, there must be a current or previous history of dizziness and at least half of the migraines must be accompanied by one or more of the following: phonosensitivity, photosensitivity, or visual aura.
  • d. To diagnose a vestibular migraine, there must be a current or previous history of dizziness and migraines must be accompanied by one or more of the following: headache, phonosensitivity and photosensitivity, or visual aura.

2. What is the most likely diagnosis if a patient presents with a single event of acute vertigo, unsteadiness, nausea and vomiting for several hours and central causes were ruled out?
  • a. Labyrinthitis
  • b. BPPV
  • c. Vestibular Neuritis
  • d. Meniere’s Disease

3. Which of the following conditions best explain which patients are optimal candidates for vestibular rehabilitation?
  • a. Medically stable and compensated
  • b. Medically unstable and compensated
  • c. Medically stable and uncompensated
  • d. Medically unstable and uncompensated

Watch the video, review the quiz questions, then log in to 360NeuroGO to complete Challenge 4!

Video 1

Challenge 7: Lesson 7

The Vestibular Clinical Exam

In this video, Bridgett Wallace, PT, DPT provides you a snapshot of the clinical vestibular exam for Lesson 7 in the CCVR 2.0 Course. This is another fan favorite among CCVR participants! Giving you deep insight is a bit of a challenge because we cover so much content.

Quiz Questions: Test Your Knowledge:

1. Which of the following provides the most insight to the cause or causes of a person’s dizziness when gathering information during the intake?
  • a. Intensity and timing of their symptoms
  • b. Timing and description of their symptoms
  • c. Intensity and description of their symptoms
  • d. Timing and triggers of their symptoms

2. Which series of bedside tests provides the most insight into the acute onset of vertigo when a patient presents with spontaneous nystagmus?
  • a. Head impulse, gaze-evoked nystagmus, and skew deviation
  • b. Oculomotor, balance, and dynamic visual acuity
  • c. Dynamic visual acuity, balance, and gait
  • d. Oculomotor, positional testing, and balance

3. Which component of the clinical reasoning cycle is critical for formulating a targeted care plan for a patient presenting with dizziness?
  • a. Identifying the patient's favorite activities
  • b. Prioritizing findings from the intake, physical exam, and special tests to formulate differential diagnoses
  • c. Determining their compliance before designing a care plan
  • d. Conducting all possible tests regardless of time constraints

Watch the video, review the quiz questions, then log in to 360NeuroGO to complete Challenge 7!

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Video 1

Challenge 8: Lesson 8

Vestibular Rehabilitation Therapy (VRT)

This video provides a brief overview of Lesson 8, Vestibular Rehabilitation Therapy or VRT.

"If you notice the title of Slide 4: Shift Happens. The meaning of this slide is to highlight the shift in theories on VOR adaptation exercises. More current research shows that the standard VOR x 1 training, as defined by the CPGs, do not result in adaptation, although we frequently refer to VOR exercises as adaptation exercises. I've been in this space for almost thirty years and have seen standard VOR exercises result in subjective and objective improvements. However, this is not due to adaptation, as discussed in the literature, but habituation. In this lesson, we'll discuss novel techniques that have shown to change the VOR gain, as well as treatment activities that result in the most optimal outcomes.” - Bridgett Wallace, PT, DPT, CCVR Course Instructor

Quiz Questions: Test Your Knowledge:

1. Which of the following is NOT typically included as part of a vestibular rehabilitation therapy (VRT) program?
  • a. Vestibular Ocular Reflex training
  • b. Ocular motor exercises
  • c. Balance and gait training
  • d. All of the above are considered VRT activities

2. What is the primary goal of habituation in vestibular rehabilitation therapy?
  • a. To enhance VOR gain through modification
  • b. To train alternative sensory systems for function
  • c. To desensitize the patient to a provoking stimulus
  • d. To compensate for complete vestibular loss

3. According to the VRT guidelines, what is a critical aspect to consider when creating a patient’s rehabilitation plan?
  • a. Adopting a one-size-fits-all protocol for consistency
  • b. Frequent journaling of symptoms
  • c. Focusing solely on facilitating sensory inputs
  • d. Customizing activities to the patient's lifestyle and goals

Watch the video, review the quiz questions, then log in to 360NeuroGO to complete Challenge 8!

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Video 1

Challenge 9: Lesson 9

The Role of the Neck in Dizziness & Balance

Watch the video, review the quiz questions, then log in to 360NeuroGO to complete Challenge 9!

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Challenge 9: Lesson 9 provides a brief overview on the role of the neck in dizziness and balance.

Take-home points from this lesson emphasize how the cervical spine can be overlooked, particularly in the vision and vestibular world, presenting an excellent opportunity to bridge this gap. It is not just about neck pain; cervical dysfunction can affect visual and vestibular processing, resulting in headaches, dizziness, spatial processing dysfunction, and unsteadiness. There is a growing body of literature supporting the importance of early intervention regarding the neck.

Again, we emphasize the importance of movement quality over quantity or intensity, and alignment over deviation. Even if you are in a facility or practice where you do not provide targeted cervical assessments or treatments, having a deeper understanding of the neck's role in dizziness can lead to more accurate diagnoses and effective treatments, ultimately enhancing the quality of life for our patients.

Quiz Questions: Test Your Knowledge:

1. Which test is NOT part of an upper motor neuron cervical screen?
  • a. Hoffman’s Test
  • b. Cervical Joint Proprioception Error Test
  • c. Scapulohumeral Test
  • d. Clonus Test

2. Which one of the following descriptions best represents a non-life threatening musculoskeletal injury following a whiplash associated injury?
  • a. Onset of a headache that worsens when being upright but lessons when lying down
  • b. Bilateral paresthesia
  • c. Delayed onset of dizziness and neck pain that worsens with 60 degrees of rotation
  • d. Central, or midline, tenderness to gentle palpation of the upper cervical spine

3. Which treatment approach is emphasized for improving outcomes in patients with neck-related dizziness?
  • a. No pain, no gain
  • b. Start with integration of dynamic balance exercises, focusing on quantity of repetitions with increasing complexity
  • c. Avoid oculomotor or vestibular exercises until the neck-related dizziness has resolved
  • d. Emphasize the importance of aligning posture and optimizing cervical position sense while integrating oculomotor and balance activities 

Video 1

Challenge 10: Lesson 10

The Role of Vision in Dizziness & Balance

Watch the video, review the quiz questions, then log in to 360NeuroGO to complete Challenge 10!

The Eyes–More Than What We See

We're so close to wrapping up the Vestibular Blueprint Challenge! A big thank you to all of you participating. Be sure to answer all the quiz questions for a chance to win a $350 Visa gift card + 1 year free membership to the the Vestibular Visionaries Network (VVN)! The winner will be selected by random drawing and announced on Instagram and during the Vestibular Blueprint Coaching Call on September 10th at 6:30pm CST.

This video will provide you with a brief overview of the Role of Vision (our eyes) in Dizziness & Balance. For this lesson, Bridgett Wallace, PT, DPT provides a key summary based on the original content from physical therapist, Natasha Johnson, who has her certificate of competency in vestibular rehab and is board-certified from the Neuro-Optometric Rehab Association (or NORA) and information about the practical anatomy and physiology of the visual system with insights from neuro optometrist and current NORA president Dean Fitzgerald.

Quiz Questions: Test Your Knowledge:

1. Which term describes the condition where the resting point of an eye(s) is aligned outward as if they are trying to exit the building?
  • a. Esophoria or esotropia
  • b. Exophoria or exotropia
  • c. Hyperphoria or hypertropia
  • d. Hypophoria or hyportropia

2. What should be assessed before implementing vergence exercises to ensure a patient has normal visual function?
  • a. Subjective Visual Vertical test
  • b. Normal physiological diplopia
  • c. Contrast Sensitivity test
  • d. Optokinetic Nystagmus test

3. What is the correct sequence of steps in vision-vestibular rehabilitation strategies, beginning with the initial focus?
  • a. Accommodation, pursuits, fixations, movement
  • b. Pursuits, saccades, fixations, cognitive load
  • c. Fixations, pursuits, saccades, movement, and body awareness
  • d. Saccades, accommodation, fixations, vision, and vestibular integration  

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Video 1

Challenge 11: Lesson 11

Special Topics:
FND-3PD-MdDS

Watch the video, review the quiz questions, then log in to 360NeuroGO to complete Challenge 11!

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Welcome back to our last lesson! In this video, Bridgett Wallace, PT, DPT provides an overview of Special Topics. There are so many to talk about! Such as Pediatrics to Aging Adults, Parkinson’s Disease & VRT, Functional Neurological / Movement Disorders, Persistent Postural Perceptual Dizziness (3PD) & Mal de DeBarquement Syndrome (MdDS), Visually-Induced Dizziness (ViD) or Visual Motion-Induced Dizziness (VMID), Dizziness in the Litigating Patient, and Psychological Considerations in Vestibular-Related Disorders.

Quiz Questions: Test Your Knowledge:

1. Which of the following statements accurately reflects a key aspect of managing functional neurological disorders?
  • a. Diagnostic testing often reveals abnormal results, requiring immediate medical intervention.
  • b. Symptoms such as tremors and inability to walk persist despite normal diagnostic testing, and treatment focuses on grounding techniques and reducing reliance on unnecessary assistive devices.
  • c. Visual changes and cognitive decline are rarely observed, and most patients require long-term use of assistive devices.
  • d. Treatment primarily involves surgical interventions and medication to address convergence spasms and tingling sensations.

2. Which of the following statements correctly describes a key difference between the treatment approaches for 3PD (Persistent Postural-Perceptual Dizziness) and MdDS (Mal de Débarquement Syndrome)?
  • a. Movement worsens both 3PD and MdDS, and both require grounding techniques for treatment.
  • b. Movement improves 3PD symptoms, while MdDS requires grounding techniques and somatosensory inputs.
  • c. Movement worsens 3PD symptoms, while MdDS can be improved by movement and uses optokinetic stripes in treatment.
  • d. Movement improves both 3PD and MdDS, with both conditions benefiting equally from vestibular inputs.

3. Which of the following definitions correctly describes catastrophization?
  • a. A cognitive distortion where a person assumes the worst possible outcome, leading to heightened anxiety and stress.
  • b. Repetitive and passive thinking about causes and consequences without engaging in problem-solving, often linked to anxiety and depression.
  • c. The repetitive continuation of a particular response, such as a word or gesture, commonly associated with brain injury.
  • d. A problem-solving strategy that involves focusing on solutions rather than causes, reducing anxiety and stress.

LEARN MORE

January enrollment is open! Enroll today and join other like-minded healthcare professionals from around the world that believe learning is a lifelong process.

Reinforce and validate your current knowledge and gain insight on how to approach challenging patients!

Certificate of Competency in Vestibular Rehabilitation (CCVR) 2.0 Course

January 2025

Orientation Week - January 20 - 24, 2025

Part 1: January 27 - March 7, 2025

Mid-Course Break: March 10 - 14, 2025

Part 2: March 17 - April 25, 2025

In Person Lab Date: May 2, 2025
*Virtual labs are available if the in person lab is not an option for you

The CCVR 2.0 Course provides you flexibility of having a learning plan that best suits your needs through a guided approach.

Coaching calls are held weekly and recorded for later viewing.

January Enrollment Is Open!

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What CCVR Course Graduates Are Saying

TESTIMONIALS

Bridgett Wallace, PT, DPT - Course Director

Kamran Barin, PhD

Shin Beh, MD

Jamie Bogle, Aud, PhD

Dana Day, AuD, CCC-A, MBA

Sally Fryer Dietz, PT, DPT, CST-D

DeAnne Fitzgerald, OD

Dr. Gerard Gianoli, MD

Denise Gobert, PT, PhD

Natalie Hiddeman, PT, DPT, NCS

Natasha Johnson, PT, MSPT

Dr. Craig Kemper, MD

Dr. James Kemper, MD

Shelly Massingale, PT, MPT

Michelle Petrak, PhD

Kendal Reddell, PT, DPT, NCS

Angela Rich, PT, OCS, ScD, ATC

Emily Schottman, OD, FCOVD, LPC

Rudie Spigarelli, PT, DPT, MTC





Faculty

TESTIMONIAL

"Modules, handouts, and coaching call discussions to elaborate on the disorder pathology, treatment strategies and interventions for balance, visual training exercises, cervicogenic dizziness, atypical BPPV presentations, concussion management, vestibular migraine, the anxious faller and various types of central dizziness. Participant questions were welcomed which reinforced simple strategies for implementing techniques. Plus the article library and video library are resources that I have lifelong access for maintaining current evidenced based strategies."
- Lana, PT, CCVR 2.0 Graduate

Read more

You will join other like-minded healthcare providers from around the world that believe learning is a lifelong process. 

Enroll Now!

The CCVR 2.0 Course provides you flexibility of having a learning plan that best suits your needs through a guided approach. Come be a part of our learning experience! 

Enroll now for $997

Easy Payment Options

Pay in full or in interest-free installments

'Shop Pay' payment plan option is only available for customers in the United States. If you live outside of the U.S. and would like to set-up a payment plan, please contact us at info@360neurohealth.com and a team member will reach out to you.

- constantine
medical doctor

"It is a great source of information by providing up-to-date literature reviews and a way to share the insights of those working 'in the trenches' with balance patients."

- Sara
PT, DPT

"I now have many resources and people to communicate with to allow me to better treat all patients and understand when something doesn't work."


- Katherine
DPT

"I loved the delivery of the course and Bridgett was amazing. I don't know how she managed to get back to everyone's individual questions. She was extremely supportive and so incredibly knowledgeable about the subject."

 - Mary
DPT

"BPPV eval and tx has changed since I took the Emory course 7 yrs ago. I wanted to know more so I could be a better clinician. I also wanted to know more on the options of treating MD and VM."

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