5 steps to becoming a skilled vestibular clinician
Are you looking to provide best practice care for patients with vertigo, dizziness, or imbalance? Vestibular assessment and/or care is currently being provided by clinicians in the following licensed professions:
- Physicians
- Audiologists
- Physical and Occupational Therapists
- Physical and Occupational Therapist Assistants
- Chiropractors/Functional Neurologists
- Physician Assistants, Nurse Practitioners, and RNs
How you go about becoming a vestibular specialist will depend on your previous training, patient population, and scope of practice for your specific degree and practice.
Here are 5 steps that can guide your progress from novice to expert status!
1. Establish Current Experience Level
To get where you are going, you need to know where you stand today. If you can answer yes to any of the following in a single group, then you likely qualify for that group:
Basic
- I did not get any vestibular training in school
- I have attended less than 12 hours (including labs) of vestibular education
- It has been more than 3 years since I had a semester or weekend basic vestibular course AND since then I have had limited experience caring for patients with vestibular issues
- I have attended more than one vestibular course, but I have very limited or no experience working with vestibular patients
Intermediate
- I had a full semester or more in school focused solely on vestibular topics within the past 3 years and have been caring for vestibular patients regularly
- I have taken at least one basic weekend or week-long vestibular course and see at least 2 vestibular patients a week on average
Advanced
- I have taken at least four continuing education vestibular courses that covered a variety of patient populations (basic, concussion, cervicogenic dizziness, etc.) AND I have worked with vestibular patients regularly for at least 5 years
- I have passed both the Duke University competency based course and the Duke competency based renewal course
2. Take Vestibular Courses
Anatomy, exam techniques, and treatment options are the solid foundations of knowledge that you’ll want to master. The anatomy is particularly important and should be thoroughly covered in your first course. Does your course of interest measure up? Based the International Guidelines for Education in Vestibular Rehabilitation Therapy, an intro course should cover evidence-based information about:
- Basic Science – Inner ear anatomy, physiology, sensory systems and integration, vestibular neural pathways (peripheral to central), etc.
- Clinical Science – Etiology, pathophysiology, epidemiology, prognosis, and potential medical or clinical interventions for vestibular conditions, differential diagnosis, cognitive/psychological comorbidities, etc.
- Specific Assessment Skills – Oculomotor exam, positional testing for BPPV, balance testing, subjective visual vertical, scales and self-assessments for patients to rate symptoms and functional issues, dynamic visual acuity testing, etc.
- Specific Treatment Skills – BPPV maneuvers, gaze stabilization and substitution exercises, habituation, balance and gait training, patient education on footwear, eye care, and environmental adaptations for safety, and appropriate frequency, duration, and individualization of plan of care and home exercise programs, etc.
As a resource, a list of course providers and conferences that cover basic, intermediate, and advanced level vestibular topics has been compiled to support your educational planning. It is highly recommended to take an in-person course for your first course to ensure you receive direct feedback regarding hands-on examination skills.
The course providers listed below are consistently rated as strong courses for physical therapists, but of course you can always read reviews and ask other trusted vestibular clinicians in your field about their recommendations as well:
- APTA
- Duke
- Education Resources Inc.,
- Emory University
- Healthclick
- International Vestibular Conference
- Skillworks
- Vestibular Seminars
Vestibular Course Providers
| Organization | Course Topics | Format | Level | Credentials |
|---|---|---|---|---|
| 360 Neuro Health | Rehabilitation; Concussion | In-Person Courses | Basic; Intermediate; Advanced | PT; OT; Aud |
| Advanced Neuro Education (Australia) | Rehabilitation; Concussion | Online Courses | Basic; Intermediate | PT; DC; DO; MD; NP; PA; OT |
| Advanced Neuro Therapy Ed (United States) | Rehabilitation | In-Person Courses | Basic; Intermediate | PT |
| American Academy of Audiology | Healthcare | Conference | Basic; Intermediate | Aud |
| American Academy of Otolaryngology | Healthcare | Conference | Intermediate; Advanced | MD; DO |
| American Balance Society | Healthcare | Conference | Intermediate; Advanced | Aud; PT; MD |
| APTA - Academy of Neurologic Physical Therapy | Rehabilitation; Concussion | In-Person Courses; Online Courses | Basic; Intermediate; Advanced | PT; OT |
| APTA - Academy of Neurologic Physical Therapy Conference | Rehabilitation; Concussion; Pediatric | Online Courses; Conference | Basic; Intermediate; Advanced | PT; PTA |
| APTA - Combined Sections Meeting | Rehabilitation; Concussion; Pediatric | In-Person Courses | Intermediate; Advanced | PT |
| APTA - University of Pittsburgh | Rehabilitation | Online Courses | Intermediate; Advanced | PT; OT; MD; DO; Aud; PA; NP |
| Association of Migraine Disorders | Healthcare | Online Courses | Intermediate; Advanced | MD; DO; PA; NP |
| Audiology Online | Healthcare | Online Courses | Basic; Intermediate; Advanced | Aud |
| Australian Physiotherapy Association | Rehabilitation | In-Person Courses; Online Courses | Basic; Intermediate; Advanced | PT |
| Carrick Institute | Chiropractic Care | In-Person Courses | Basic; Intermediate; Advanced | DC |
| CNS-Ed | Concussion; Rehabilitation | Online Courses; In-Person Courses | Intermediate; Advanced | DC; PT; MD; DO; ATC |
| Combined Otolaryngolgy Spring Meetings | Healthcare | In-Person Courses | Intermediate | MD; DO |
| Complete Concussions | Rehabilitation; Chiropractic Care; Healthcare | Online Courses | Basic; Intermediate; Advanced | PT; OT; NP; PA; ATC; DC; MD; DO |
| Concussion Corner Academy | Concussion; Rehabilitation; Cervicogenic | Online Courses | Intermediate; Advanced | PT; PA; NP; MD; OT; ATC |
| Dizziness and Balance Rehabilitation Clinic in Canada | Rehabilitation; Concussion | In-Person Courses | Basic; Intermediate; Advanced | PT; OT; MD; DO; DC |
| Education Resources, Inc. | Rehabilitation; Concussion; Cervicogenic; Pediatric | In-Person Courses; Online Courses | Basic; Intermediate; Advanced | PT; PTA; OT; OTA; Aud |
| Elite Rehabilitation Solutions | Rehabilitation; Concussion | In-Person Courses; Online Courses | Basic; Intermediate | PT |
| Emory University Competency Based Course | Rehabilitation | In-Person Courses | Intermediate; Advanced | PT; OT; MD; DO |
| Functional Neurology Seminars | Chiropractic Care | Online Courses | Intermediate; Advanced | DC |
| Great Lakes Seminars | Rehabilitation | In-Person Courses | Basic | PT |
| Healing Vertigo | Rehabilitation; Concussion | Online Courses | Basic; Intermediate | PT; OT; Aud |
| Healthclick | Rehabilitation; Concussion | In-Person Courses; Online Courses | Basic; Intermediate; Advanced | PT; PTA; OT; OTA |
| International Association of Functional Neurology and Rehabilitation | Chiropractic Care | Conference | Basic; Intermediate; Advanced | DC |
| International Symposium on Clinical Neuroscience | Chiropractic Care | Conference | Intermediate; Advanced | DC |
| International Vestibular Conference | Healthcare; Rehabilitation | Conference | Intermediate; Advanced | PT |
| Johns Hopkins Competency Course | Rehabilitation; Healthcare | In-Person Courses; Online Courses | Advanced; Intermediate; Basic | MD; DO; PT; PTA |
| Labyrinth PT | Rehabilitation | In-Person Courses; Online Courses | Basic; Intermediate | PT; PTA |
| Mayo School of Continuous Professional Development | Healthcare | Conference | Intermediate; Advanced | MD; DO |
| Medbridge | Rehabilitation | Online Courses | Basic; Intermediate | PT; PTA; OT; OTA |
| Motivations, Inc. | Rehabilitation; Pediatric | In-Person Courses | Basic; Intermediate | PT; PTA; OT |
| Noesis Therapy Seminars | Concussion; Rehabilitation | In-Person Courses; Online Courses | Basic; Intermediate; Advanced | PT; OT; DC; Aud; PA; PTA; OTA |
| North 49 Therapy | Rehabilitation | Online Courses; In-Person Courses | Basic; Intermediate | PT |
| OTcourses.com | Rehabilitation | Online Courses | Basic; Intermediate; Advanced | OT; OTA |
| PESI Rehab | Rehabilitation | In-Person Courses | Basic; Intermediate | PT; PTA; OT; OTA; MD; DO; Aud |
| Posture and Balance Concepts | Rehabilitation | In-Person Courses | Basic; Intermediate | PT; PTA; OT; OTA |
| Shirley Ryan Ability Lab Academy | Rehabilitation | In-Person Courses | Basic; Intermediate | PT; PTA; OT; OTA |
| Skill Works | Rehabilitation; Cervicogenic | In-Person Courses | Basic; Intermediate | PT |
| Specialty Therapy | Rehabilitation; Pediatric | In-Person Courses; Online Courses | Basic; Intermediate; Advanced | PT; PTA; OT; OTA |
| Summit Professional Education | Rehabilitation | Online Courses | Basic | PT; PTA; OT; OTA |
| Therapy Insights | Rehabilitation | Online Courses | Basic; Intermediate | PT; OT; OTA; PTA |
| Therapy Network Seminars | Rehabilitation | In-Person Courses | Basic; Intermediate | PT; PTA; OT; OTA |
| University of Manchester | Healthcare | Online Courses | Intermediate; Advanced | Aud |
| University of Pittsburgh | Rehabilitation; Concussion; Cervicogenic | Online Courses; In-Person Courses | Advanced | PT |
| Vestibular Educators | Rehabilitation | In-Person Courses; Online Courses | Basic; Intermediate | PT; PTA; OT; OTA |
| Vestibular First | Rehabilitation; Healthcare; Concussion; Pediatric; Cervicogenic; Chiropractic Care | Online Courses | Basic; Intermediate; Advanced | Aud; DC; DO; MD; NP; OT; OTA; PA; PT; PTA; ATC |
| Vestibular IQ | Rehabilitation; Concussion; Cervicogenic | In-Person Courses; Online Courses | Basic; Intermediate; Advanced | PT; PTA |
| Vestibular PT | Rehabilitation | In-Person Courses | Basic; Intermediate | OT; PT; PTA |
| Vestibular Today | Rehabilitation | In-Person Courses; Online Courses | Basic; Intermediate | PT; PTA; OT; OTA; Aud |
3. Find a mentor or “Board of Directors”
In order to get guidance as you examine and treat patients with dizziness, you will want to find an experienced clinician to mentor you, likely from your same discipline if available. You can have 3-5 mentors, also known as your “board of directors,” who you can email, call, or video chat with questions that arise as you see more patients with dizziness and imbalance. If mentors are not available within your organization, useful ways to find them can include:
- Local vestibular clinicians in the Vestibular Disorders Association
- Contact the largest hospital networks in your area that have vestibular therapists or a balance center to ask about potential mentorship or vestibular education groups for clinicians in the region
- Vestibular course instructors and lab assistants
- Specialty section websites
- Discipline-specific mentorship programs such as the Clinical Mentorship Program through the Academy of Neurologic Physical Therapy
4. Get experience examining patients with the proper tools
Once you’ve gained knowledge by taking coursework, it is essential to get experience working with vestibular patients. A critical part of a vestibular exam is watching eye movements during the oculomotor and positional testing portions. Some of these tests should be done with visual fixation removed (in the dark) to maximize the likelihood of visualizing and recording any abnormal eye movements. Baba et al. (2004) found that if you are using traditional thickened lens Frenzels instead of infrared video goggles (video Frenzels) to view eye movements in the dark, you can miss 66% or more of abnormal eye movements in patients with vestibular pathology. Other important tools can include a tape measure or accommodation ruler to measure convergence, an eye chart for measuring dynamic visual acuity, and an eye occluder for testing for skew deviations. For a helpful list of tools, check out our Essential Equipment for a Vestibular Rehabilitation Clinic.
5. Keep connected for advanced skills and knowledge building
Choose as many resources below as you can to keep your vestibular care fresh, current, and evidence-based and to maximize your connections with leaders in the field:
- Join VEDA to be listed on their Vestibular Specialist Healthcare Provider Director
- Read vestibular textbooks such as Herdman and Clendaniel’s seminal text, Vestibular Rehabilitation (4th edition)
- Review vestibular topics on Dr. Hain and Dr. Cherchi’s comprehensive Dizziness and Balance website
- Download the aVOR app (iOS) for VOR representation with and without pathology
- Explore the BPPVviewer for 3D orientation of the vestibular canals
- Check out the Dan Gold Neuro-Ophthalmology Collection of eye movement videos (normal and pathologic)
- Network with course and conference lecturers and attendees
- Connect with discipline-specific groups on Facebook such as the Functional Neurology group or Vestibular Rehab SIG for informative posts such as “Abstract of the Week” and patient case discussions
- Check out blogs that cover vestibular topics by authors such as BC Balance and Dizziness or neuro PT Bria Varner
- Follow leaders in vestibular academic research and care on Twitter
- Attend advanced topic conferences such as the Barany Society Meeting 2020 or the International Vestibular Conference
- Share recorded eye movement videos (with patient permission as per HIPAA guidelines) with experienced colleagues, discuss patient cases in person or remotely, and integrate feedback into your practice
- Discover vestibular-specific home exercise program options such as TherEx Portal or Balance Retraining
- Ask to observe other clinicians of various disciplines on a vestibular care team, such as vision therapists, to improve your referrals to those disciplines
- Subscribe to YouTube Channels such as Physical Therapy Nation for videos on exam and treatment techniques or PT Video Source for optokinetic videos when treating patients with visual vertigo
- Sign up for Google Alerts to get daily or weekly updates on new posts using keywords such as vestibular or vertigo
- Attend webinars and listen to podcasts regarding evidence-based practice such as the APTA Vestibular SIG or Otolaryngology Podcasts
The field of vestibular care is fascinating in its complexity, rewarding in its ability to literally change the lives of clients who receive quality care, and challenging in its constant evolution of new techniques for evidence based examination and treatment. Should you choose to move forward on your journey to become an experienced vestibular clinician, we applaud and welcome you to this grand adventure. Gaining these skills requires dedication and time, but when done well, it is completely worth the effort!
Questions? Have more tips to recommend? Contact [email protected]!