Academy of Neurologic Physical Therapy Podcast · Academy of Neurologic Physical Therapy

Vestibular SIG: Fall Risk Uncovered: A Vestibular Connection

·28 min·1 clip

He was told not to rely on a walker, then lost his balance immediately with his eyes closed every session.

1. Academy of Neurologic Physical Therapy Podcast’s "Fall Risk Uncovered: A Vestibular Connection" focuses on an 83-year-old inpatient rehab case with falls and vestibular findings. 2. Maureen Kroger hosts Holly Paxson, a physical therapist at Shirley Ryan Ability Lab, and Sarah Oxborough, a vestibular clinician at University of Minnesota Physicians and Director of Education for Vestibular First. 3. The episode asks what vestibular screening adds when an older adult presents as a faller rather than as a dizzy patient. 4. Holly’s patient had coronary artery disease, COPD, bladder cancer, spinal stenosis, thoracic discitis, osteomyelitis, and multiple C3-L2 fusion surgeries. 5. He was admitted to inpatient rehabilitation after a fall with head strike, craniectomy, and traumatic brain injury. 6. Before that admission, he had frequent falls at home that were attributed to poor balance and neuropathy. 7. Holly says outpatient PT had not included a vestibular exam and had him work with eyes closed or vision occluded by goggles. 8. He reported losing his balance immediately during every PT session and was advised not to rely on an assistive device at home. 9. Because of his traumatic brain injury, Holly’s inpatient rehab team automatically referred him for a vestibular exam. 10. The exam included ocular motor testing, head thrust testing, dynamic visual acuity, positional testing, and balance measures. 11. Results showed bilateral positive head thrust, an eight-line dynamic visual acuity loss, negative BPPV testing, MCTSIB 60 out of 120 seconds, and Berg 8 out of 56. 12. Holly interpreted those findings as consistent with chronic bilateral peripheral hypofunction. 13. Sarah said a quick ocular motor screen for smooth pursuit and saccades can help identify central dysfunction. 14. Sarah also described head impulse testing, video infrared goggles, and post-head shake nystagmus as useful parts of vestibular screening. 15. She pointed out that older adults with BPPV may present with imbalance instead of classic dizziness or positional vertigo. 16. Sarah cited a 2023 systematic review and meta-analysis of 460 patients showing vestibular dysfunction in 61% of older adult fallers. 17. She also referenced a 2000 community-dwelling geriatric study in which about 10% had unrecognized BPPV. 18. The conversation stays practical and case-based, with Holly and Sarah trading screening tips and treatment implications. 19. Clinicians who treat older adults with falls, traumatic brain injury, or vestibular complaints would likely find it useful. 20. Clinicians looking for a broader theoretical discussion or a nonclinical interview may skip it.

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