1 day course Cervical Masterclass: Cervicognenic Dizziness & Differential Diagnosis.

Cervical Masterclass: Cervicogenic Dizziness &

Differential Diagnosis. Includes post-concussion syndrome

HOW DO WE ASSESS AND TREAT A PATIENT WITH

CERVICOGENIC DIZZINESS

COURSE DATE: WEDNESDAY 22 MAY 2019 VENUE: Glasgow Caledonian University Room A248a Physiotherapy Room 2nd Floor Govan Mbeki Building Glasgow G4 OBA FEE: £130.00 per person

TUTOR: DR SUE REID

PhD MMedSc(Phty), GradDipManipTher,BAppsSc(Phty),BPharm Qualifications Sue is a senior lecturer in musculoskeletal physiotherapy at the Australian Catholic University in North Sydney where she teaches undergraduate Physiotherapy students. In the past she has taught anatomy to Physiotherapy and Medical students. Experience She is a Titled Musculoskeletal Physiotherapist, a certified Mulligan practitioner and member of the Mulligan Concept Teachers Association (Honorary) with post graduate training in the Mulligan Concept, as well as the the Maitland and McKenzie physiotherapy methods. Sue has completed her PhD and a research masters on the identification and treatment of people with cervicogenic dizziness and pain. This has also involved the diagnosis and treatment of dizziness from other causes such as the vestibular system and vertebral artery. She is currently doing research on the assessment and management of people with ongoing sports related concussion symptoms. Her other research topics are ‘Text Neck’, proprioceptive and balance disturbances in people with neck pain, and neurodynamic testing in the upper limb. She has just completed a randomised controlled trail on addition of Mulligan glides to exercise and advice, after a distal radius fracture. She has published in international journals, written a textbook chapter and presented and run workshops at many international conferences such as WCPT, IFOMT and the International Mulligan Conferences. Her clinical interests are the treatment of neck pain, dizziness, headaches, concussion and TMJ problems.

1 day course Cervical Masterclass: Cervicognenic Dizziness & Differential Diagnosis.

Publications by Sue Reid Book Chapter Reid Susan, Rivett Darren Anthony, ‘A diagnostic dilemma of dizziness’, In Vicenzino, B., Hing, W., Rivett, D.A. and Hall, T. (2011) Mobilisation with movement: The art and the science, Elsevier Australia, Chatswood, NSW, 114-122. Journal publications Reid SA & Rivett DA. (2005) Manual therapy treatment of cervicogenic dizziness: a systematic review. Manual Therapy, 10:4-13. Reid SA, Rivett DA, Katekar MG & Callister R. (2008) Sustained natural apophyseal glides (SNAGs) are an effective treatment for cervicogenic dizziness. Manual Therapy, 13:357–366. Reid SA, Rivett DA, Katekar MG & Callister R. (2012) Efficacy of manual therapy treatments for people with cervicogenic dizziness and pain: protocol of a randomised controlled trial. BMC Musculoskeletal Disorders, 13:201-208. Reid SA, Rivett DA, Katekar M & Callister R. (2014) Comparison of Mulligan Sustained Natural Apophyseal Glides and Maitland Mobilizations for Treatment of Cervicogenic Dizziness: a Randomized Controlled Trial. Physical Therapy, 94:466-476. Reid SA, Rivett DA, Katekar M & Callister R. (2014) The Effects of Cervical Spine Manual Therapy on Cervical Range of Motion, Head Repositioning and Balance in Participants with Cervicogenic Dizziness: A Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation, 95:1603-12. Reid SA, Callister R, Snodgrass SG, Katekar MG & Rivett RA. (2015) Manual therapy treatment of cervicogenic dizziness: long-term outcomes of a randomised controlled trial. Manual Therapy, 20:148-156. Reid SA, Callister R, Katekar MG, Treleaven JM. (2017) Utility of a brief assessment tool developed from the Dizziness Handicap Inventory to screen for Cervicogenic dizziness: A case control study. Musc Science and Practice, 30: 42-48 Reid SA. (2017)Neck Dizziness. Phone App on Android and Apple devices

Learning Objectives:

On completion of this session you should be able to: • Understand what cervicogenic dizziness is and how it differs from other types of

dizziness. • Interview a person with neck pain and dizziness • Perform a physical assessment of the cervical spine with emphasis on assessment of the

upper cervical spine. • Assessment of VBI • Assessment of people with prolonged symptoms after a concussion injury. Treatment of

patients with cervicogenic dizziness, prolonged post-concussion syndrome and BPPV This workshop will include

1) Review of dizziness and its classification, types and causes 2) What is cervicogenic dizziness 3) How we identify cervicogenic dizziness 4) Case study (This will be followed through the examination for clinical

reasoning) 5) Patient Interview to identify cervicogenic dizziness

Establishing: - neck dysfunction - type of dizziness is unsteadiness and not rotatory dizziness - neck movements and if they trigger dizziness - recognize other causes of dizziness such as cardiovascular dizziness, vestibular problems, Benign Paroxysmal Positional Vertigo (BPPV), vertebra-basilar insufficiency (VBI) and migraines

1 day course Cervical Masterclass: Cervicognenic Dizziness & Differential Diagnosis.

Use of short questionnaire (Reid et al 2017) and phone app to identify those with cervicogenic dizziness.

6) Physical evaluation of cervical spine, emphasizing upper cervical spine and assessment to determine if dizziness is possibly coming from the neck

a. Active range of motion (ROM) with over pressure especially of the upper cervical spine b. Passive accessory palpation examination of the cervical spine with passive accessory inter

vertebral movements (PAIVMS) (central and unilateral and transverse passive accessory glides) as described by Geoff Maitland

c. Passive physiological intervertebral movements (PPIVMS) for upper and lower cervical spine d. Clinical tests to rule in or out cevicogenic dizziness such as the Smooth Pursuit Neck Torsion

Test e. Assessment of BPPV with Dix-Hallpike manoeuvre f. Assessment of ligaments in upper cervical spine e.g. Sharp-Purser, alar ligament and

tectorial membrane tests g. Vestibular Ocular Motor Screening (VOMS) h. Assessment of cervical spine proprioceptive deficits with head repositioning testing i. Assessment for VBI: Assessment for cardio vascular dizziness

7) Treatment Treatment of cervicogenic dizziness

a. Sustained Natural Apophyseal Glide (SNAG) for extension b. SNAG for rotation c. Self-SNAGs d. Passive joint mobilization

Assessment of patients with persistent symptoms after a concussion injury. Discussion of symptoms post sports concussion: dizziness, headache, neck pain, visual disorders, fatigue, irritability and fogginess. Assessment Treatment of individuals with prolonged post-concussion symptoms

a. Graded exercise b. Treatment of cervical spine c. Treatment of occulo-motor dysfunction d. Balance exercises e. Vestibular rehabilitation f. Treatment of proprioceptive deficits

Treatment for BPPV

a. Epley manoeuvre b. Brandt-Daroff exercises

1 day course Cervical Masterclass: Cervicognenic Dizziness & Differential Diagnosis.

Cervical Masterclass: Cervicognenic Dizziness & Differential Diagnosis

Includes post-concussion syndrome

GLASGOW CALEDONIAN UNIVERSITY Room A248A Physiotherapy Room

WEDNESDAY 22ND MAY 2019

PROGRAMME

8.30 Registration/Coffee

Part A: Cervicogenic Dizziness

9-10.30 Morning Session 1

9-9.30 Lecture

• Review of dizziness and its classification, types and causes

• What is cervicogenic dizziness and how it differs from other types of dizziness

• Recognize other causes of dizziness such as cardiovascular dizziness, vestibular problems, Benign Paroxysmal Positional Vertigo (BPPV), vertebro-basilar insufficiency (VBI) and migraines

• How we identify cervicogenic dizziness

• Use of short questionnaire (Reid et al 2017) and phone APP to identify those with cervicogenic dizziness.

• How to interview a person with dizziness and neck pain

• Case study (will be followed through the examination for clinical reasoning)

9.30-10.30 Performing a physical assessment of cervical spine, emphasizing upper cervical spine -Practical session

• Active range of motion (ROM) with over pressure including upper cervical spine

• Palpation of soft tissues

1 day course Cervical Masterclass: Cervicognenic Dizziness & Differential Diagnosis.

• Passive accessory palpation examination of the cervical spine with passive accessory inter vertebral movements (PAIVMS) (central and unilateral and transverse passive accessory glides) as described by Geoff Maitland

• Passive physiological intervertebral movements (PPIVMS) for upper and lower cervical spine

• Clinical tests to rule in or out cervicogenic dizziness such as the Smooth Pursuit Neck Torsion Test, Cervical Flexion Rotation Test

10.30-11 Coffee

11-12.45 Morning Session 2

11-11.45 Performing a physical assessment - Practical session (cont)

• Assessment of cervical spine proprioceptive deficits with joint position sense testing (laser),

• Cranio-cervical flexion test (CCFT)

• Balance testing

11.45-12.45 Treatment of patients with cervicogenic dizziness – Lecture 10 mins then practical session

• Evidence for treatment of cervicogenic dizziness

• Sustained Natural Apophyseal Glide (SNAG) for extension

• SNAG for rotation

• Self-SNAGs

• Passive joint mobilization

12.45-1.30 Lunch

Part B Differential Diagnosis

1.30- 3.30 Afternoon Session

1.30-2.15 Vestibular dizziness, BPPV, central dizziness (Lecture and prac)

• Assessment of BPPV with Dix-Hallpike manoeuvre

• Epley manoeuvre

• Brandt-Daroff exercises

1 day course Cervical Masterclass: Cervicognenic Dizziness & Differential Diagnosis.

2.15-3.30 Post-concussion Syndrome: assessment and treatment (Lecture 45 min , practical session 30mins)

Includes vestibular ocular motor screening (VOMS), near point convergence, Optokinetic testing, evaluation of exercise tolerance

Treatment of individuals with prolonged post-concussion symptoms

• Cervical interventions

• Treatment of proprioceptive deficits

• Treatment of ocular motor dysfunction

• Balance exercises

• Vestibular interventions

• Exercise rehab

3.30-4.00 Coffee

4.00 -5.00 Afternoon Session 2 (Lecture and practical session)

• Vertebro-basilar insufficiency (VBI) and craniocervical arterial dissection (CAD). Assessment for VBI: including latest guidelines from IFOMPT and Aust Physio Association

• Assessment of ligaments in upper cervical spine e.g. Sharp-Purser, alar ligament and tectorial membrane tests

• Migraine

• Assessment for cardio vascular dizziness

• Questions and Finish

1 day course Cervical Masterclass: Cervicognenic Dizziness & Differential Diagnosis.

Directions to venue Glasgow Caledonian University Room A248a Physio Room 2nd Floor Govan Mbeki Building Cowcaddens Rd Glasgow G4 0BA Please follow link for further information https://www.gcu.ac.uk/theuniversity/howtofindus/ Glasgow Caledonian University’s single-site campus sits in the centre of Glasgow, with easy access to all air, rail and road links. If you’re driving, the university is very close to the M8 motorway for quick access to Edinburgh and Glasgow Airport. We’re also within easy walking distance of Glasgow Queen Street and Glasgow Central railway stations, Buchanan Bus Station, and the underground rail system. Walking Glasgow's an easy city to walk around. Use WalkIt.com to plan your route and find out how long it will take you, how many steps you'll use and even how many calories you'll burn (865 steps and 42 calories between Glasgow Queen Street Station Bicycle The university has lots of secure cycle racks where you can park your bike. Find out more about cycling in Glasgow. Bus The university is directly opposite Glasgow's main bus terminal Buchanan Bus Station. Underground The university is a short walk from Cowcaddens underground station - great for seeing some more of the city while you are here. Rail Situated in the city centre, our Glasgow campus is a short walk from Glasgow Queen Street Station and about 20 minutes walk from Glasgow Central Station. Visit National Rail Enquiries Service for train times. Car The university is easily accessible from Junction 16 (Westbound) or Junctions 15 & 17 (Eastbound) of the M8 motorway. Although no parking is available on campus, the nearest car parks to the university are a short walk away:Concert Square - Reduced Parking Rates available for delegates

• Concert Square multistorey on Cowcadeens road

1 day course Cervical Masterclass: Cervicognenic Dizziness & Differential Diagnosis.

Airport Glasgow Airport is situated approximately 10 miles to the west of the City Centre - approximately 30 minutes by taxi. There is also a direct bus link to Buchanan Street Bus Station, which is 200 yards from the university. Hotels and Facilities Need a hotel room in Glasgow? Glasgow Caledonian University has partnered with a variety of hotels in the local area to provide you as a member of staff, a guest of the university, a student or an event organiser booking with the university with reduced rates for accommodation in the city. The rates are also open to friends and relatives. Our handy brochure describes the hotels and their rates to help you make the best choice for you and your guests.

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Refreshments Although we will be providing refreshments lunch is not included. There is a Garden Café located on the ground floor of the same building

1-day on course – 7 hours CPD certificate handed at end of course signed by tutor

1 day course Cervical Masterclass: Cervicognenic Dizziness & Differential Diagnosis.

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