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