1. Experiences with overseas Vestibular Clinics Anne McGann Senior Clinician Physiotherapist Churchill Fellow 2003

2. programme: 5 weeks in USA visiting: Johns Hopkins Medicine Emory University Pittsburgh University Medical Centre NYU RUSK Institute 2 weeks UK visiting Charing Cross Hospital National Hospital for Neurology & Neurosurgery

3. vestibular clinics in usa Diagnostic & Rehabilitation co-existed Standard lab tests 1:1 customised therapy intervention Specialised clinics ENTs & Physios or Neurologists & Physios Research occurring

4. johns hopkins medicine vestibular rehabilitation baltimore usa - dr richard clendaniel pt phd Dept of Otolaryngology Vestibular Clinic ENTs Neurologists Physiotherapist Diagnostic: Rotary Chair Calorics Auditory Testing Posturography Rehabilitation: Physio assessed, treated & set up programme, HEP, Reviews +/- refer out to Physio Depts

5. emory university: dizziness & balance centre atlanta usa dr susan herdman pt phd, dr ron tusa md phd Balance & Dizziness Centre Neurologists X3 physios Lab assistants Diagnostic: Calorics Rotary Chair VEMP SVV Posturography Rehabilitation: Physio assessed, treated, set up programme, HEP, Reviews

6. pittsburgh university medical centre: balance centre - vestibular rehabilitation program pittsburgh usa - dr sue whitney pt phd Neurology Clinic Neurologists Diagnostic: Calorics, Rotary Chair Posturography Rehabilitation: Balance Centre: Vestibular Rehabilitation Program X3 physios Physios assessed, treated, set up programme, HEP, Reviews

7. new york university medical centre: rusk institute: vestibular rehabilitation program new york usa -tara denham pt Vestibular Rehabilitation Program X9 physios! Diagnostic: Clinical diagnostic skills Posturography Rehabilitation: Physios assess, treat, set up program, HEP, Reviews

8. standard clinical assessment: Central signs Smooth pursuit Saccadic eye movements Peripheral signs: Hallpike-Dix Head Thrust Test Balance measures: SOT Gait Functional Reach Disability & Handicap: A fear of falling scale Dizziness Handicap Inventory

9. Vestibular clinics in uk Diagnostic neuro-otology clinics – medical and lab tests Not “balance centres” Neurologists Standard lab tests +/- refer to vestibular rehab programmes Cawthorne Cooksey habituation approach Group sessions +/- 1:1 approach Research occurring Primary care approach

10. charing cross hospital: neuro- otology clinic charing cross uk - prof aldolfo bronstein md Neuro-otology clinic Neurologists Diagnostic: Calorics Rotary Chair Rehabilitation: No direct link Drs treated BPPV

11. national hospital for neurology & neurosurgery: neuro-otology clinic queens square uk - prof linda luxon md Neuro-otology Clinic Neurologists Audiologists Diagnostic: Calorics Rotary chair Auditory tests Rehabilitation: Part of physio dept workload Group Cawthorne & Cooksey exercise and Ed sessions Review in 6/52s for need for 1:1 therapy

12. evidence for vestibular rehabilitation (vr): Customised VR vs general conditioning exs & vestibular suppressant medications (Horak et al1992) Unsupervised Cawthorne-Cooksey exs vs supervised customised VR (Szturm et al1994) Customised habituation HEP vs control (Yardley et al 1998)