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C/o Dizziness (Last seconds with movement (Check Dix-Hallpike ((-) Perform…
C/o Dizziness
Last seconds with movement
Check Dix-Hallpike
(+) Treat for BPPV- see BPPV coggle
(-) Perform MSQ
(+) Symptoms, treat with VRT
(-) Assess balance
(+) impairment, perform dynamic balance ex's
(-) imbalance, reassess
Constant symptoms
Are symptoms acute or chronic?
Acute
Neurological Exam
(+) Central Findings, refer to ER or Neurology
(+) Peripheral vestibular findings
Treat with VRT, refer to ENT if needed
Chronic
Exam- r/o cardiogenic, psychosomatic, endocrinologic, central etiology
Other conditions ruled out, treat / trial VRT, possible referral to psych services if needed
Possible etiology identified, refer to appropriate healthcare practitioner
Lasts minutes with movement
Any symptoms related to dizziness
(+) Cervical pain
Assess C-Spine
(+) C-spine findings and associated dizziness
Treat with manual therapy
(-) C-spine findings
Reassess
(+) Headache
Trial manual therapy, postural education, stress reduction and r/o migraine
Symptoms improved, maintain current treatment
No improvement in headache or dizziness
Refer to neurologist
Symptoms of headache improved, but still demonstrating positional dizziness
Treat with VRT
Headache associated w/ central findings, refer to ER/ Neurology
(+) numbness/ tingling and/ or weakness
Refer to Neurology
Lasts minutes to hours with and without movement
Neuro exam, any cervical involvement or headache
Headache, refer to other pathway
Cervical pain correlated with dizziness
Refer to other pathway
Demonstrates (+) vestibular signs on exam
Treat with VRT
Inconclusive findings on exam, refer to ENT/ Neurology