Physical Therapy in the DoD - PowerPoint PPT Presentation

Physical Therapyin the DoD

CDR Henry McMillan, PT, DPT

LCDR Alicia Souvignier, MPT, DPT, GCS

• Identify the common patient presentations seen by PHS PTs working in the DoD
• Be able to indentify key aspects of the evaluation of a dizzy patient
• List 3 treatment techniques used to treat dizziness

• Incident in theatre results in Medivac to CONUS
• After redeployment, troops inprocess through the Soldier Readiness Center, where history of concussion is identified
• Soldiers with possible residual symptoms of concussion, are referred to the TBI clinic.

• Optimistic expectation for full recovery
• Therapists incorporate assessment of the Service Members goals and priorities along with MTBI related symptoms

• Vestibular Dysfunction
• Balance Complaints
• Post Traumatic Headache
• Temporomandibular Joint Dysfunction
• Attention and Dual-Task Deficits
• Fitness/ Activity intolerance
• Musculosketetal complaints

• DHI Score > 11 (Yes to any F’s or P’s)
• Plus yes to one of the following:
• R/SR (Eyes Closed) less than 30 seconds- (arms across chest)
• VOR x1 for less than one minute with onset of symptoms
• Walking with HT increase symptoms, deviated gait, LOB- (Museum Gait)

• If the patient reports any of the following
• Difficulty with balance or dizziness that is affecting their functional performance
• Unsteady while standing still or walking, in poor lighting, or in crowds
• Difficulty with balance on uneven surfaces
• Intense spinning, lightheadedness, or unsteadiness associated with exercise

• Vestibular Lesions or hypofunction
• Unilateral- infection/neuritis, lesions, bppv
• Bilateral- ototoxic medications
• Central processing
• Central lesions- brainstem, cerebellum
• Migranes
• Anxiety
• Cervicogenic dizziness
• Vertebrobasilar insufficiency
• Altered proprioceptive signals

• Subjective
• MOI or idiopathic
• Frequency/Intensity/duration
• Vision/ Hearing deficits
• Positional/activity induced
• Valsalva/ pressure changes
• Describe symptoms of dizziness
• Vertigo
• Imbalance
• Lightheadedness

• Subjective
• Activity Level
• Recreational Sports
• Exercise Tolerance
• Unit Physical Training
• Behavioral Health
• Quality of Life
• DHI
• Family Participation
• Command/Unit Support

• Musculoskeletal Screen
• Positional Testing
• Oculomotor
• Balance

• Smooth Pursuit
• Saccadic
• VOR

• Vestibular Ocular Reflex
• Vestibular system sends information regarding speed of movement to the visual system. Allows us to keep focus while performing functional head motions.

• Head Thrust Test
• Grasp patients head firmly
• Tilt patient’s head to 30 deg flex
• Move head back and forth slowly and instruct patient to keep focus on target
• Provide a quick movement through a small range and watch for patient’s ability to refocus on target.
• Refixation saccade indicates decreased VOR

• Dynamic Visual Acuity
• Test visual acuity on a Snellen Chart
• Turn patients head vertical and horizontal plane to the beat of a metronome at 2Hz
• Retest visual acuity while you are moving the patient’s head.
• 3 lines loss is significant

• Dizziness caused by certain positions
• Spinning
• Use Frenzal goggles
• Dix Hallpike
• BPPV
• Motion Sensitivity Quotient
• Motion Sensitivity

• Dix Hallpike
• Long sitting, head turned 45 deg, drop down with neck into about 30 deg of extension

• Functional Gait Assessment
• Romberg/ Sharpened
• Neurocom or M-CTSIB

• Adaptation Exercises: adapting residual vestibular function to make up for lost function
• Example: Maintain visual fixation on object while the head is moving
• Substitution Exercises
• Doing exercises with and without visual cues
• Habituation Exercises
• Repeated exposure to provocative stimulus, for example motion sensitivity.

• Walking head turns
• Tracking with eyes
• Tracking with head movements
• All of the above together
• Above exercises on varied surfaces

• Brandt Daroff (picture)
• Positions identified from MSQ

• Canalith Repositioning Technique
• Liberatory Maneuver

• Prioprio
• Neurocom-
• Balance activities- SOT
• Foam
• Unstable surface
• Uneven terrain

• Foam bowling
• Bear claws
• Soccer Toss
• Wii
• Dance Revolution
• Discoball/strobe with balance

• Return to Duty
• Goals for Civilian Life