In this particular period of health crisis, the educational team had to adapt its teaching in order to pursue educational continuity. It is for this reason that Mr Blin welcomed us by videoconference in his cabinet to present us his activity. Indeed, this physiotherapist is specialized in the vestibular field which aims to rehabilitate vertigo and balance disturbances of neurosensory origin. His practice, through the multidisciplinary component it involves, requires a close link with other health professionals such as ENT doctors, ophthalmologists or orthoptists.
We were able to follow the progress of vestibular management from maintenance to rehabilitation through clinical examination. To do this, he sought the help of a cameraman and a patient.
Initially, the interrogation must make it possible to target the disorder and the triggering situation. Among the questions we can ask to discriminate these disorders :
Do you see a blurred image ?
Do you feel dizzy ?
Does the positioning of your head influence your troubles ?
What are the circumstances of occurrence of these disorders ? (Seasickness, motion sickness, acrophobia)
Do you have sensations of drunken walking ? (Do not walk straight, knock on doors)
This subjective examination guides us for the diagnosis, but it must be validated by imaging: the injected scanner or MRI which are the techniques of choice.
After the interview, he was able to present the various elements of the clinical examination to us. The first point to check is under the acronym HINTS which includes:
Search for nystagmus detectable with the naked eye
If these tests are positive it may be a sign of central impairment and therefore requires reorientation.
Subsequently, he presented us with various tests for the key points of the clinical examination. :
Oculomotor tests (manual or graphic) to unseal any hyper or hypometry :
dentification of the nystagmus and these different phases by writing allowing communication with doctors :
A test for quick cells
Sensory orientation tests for balance which test 3 dimensions: somesthesic, vestibular and visual.
Concerning the treatment part, it was a discovery for the students because this reeducation is notably based on unpredictability, on the work of vestibular strategy and does not consist in a classic muscular reinforcement. Consequently, the markers will not have the same clinical value and we will have to develop our vigilance and that of the patient when nausea arrives, for example. Among the other elements of care specific to vestibular rehabilitation, Mr. Blin noted the importance of the duration of the session around 15-20 min in view of the energy cost of this type of exercise. He was able to show us examples of rehabilitation, including the use of virtual reality through role-playing to work on acrophobia or motion sickness, among others.
Another axis of treatment lies in the chair work with rotational movements associated with eye tracking movements.
The presentation of this specific rehabilitation constitutes a real added value in our training. We thank Mr. Blin for presenting his activity to us and for giving us the keys to the understanding that will need to be deepened for our future practice.