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Vestibular Rehabilitation
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  Julie Knoll PT, NCS


Course Description:  

This is an advanced course that will cover dizziness of all types, gaze instability, oculomotor and visual dysfunction, imbalance, righting responses, and positional vertigo. A special session on Concussion will be held. Vestibular and balance system sensory-motor neuroanatomy function and pathology will be presented, along with vestibular, cervical and visual disorders. Specific evaluation tests and measures, interventions and therapeutic exercise progression will be covered in the areas of dizziness habituation, balance training, oculomotor and gaze stability, and particle repositioning. While teaching the common principles of evaluation and treatment of the patient with dizziness and imbalance from vestibular-cervical-ocular disorders, this course goes a step further in assisting the clinician in adequately classifying patients to determine which sub-type

symptom groups will respond best to particular interventions. This improves the outcome and reduces the duration of treatment by making the most effective treatment decisions, once the differential diagnosis is identified. The Classification System that will be presented has been developed over a period of 25 years working with dizzy patients in a multidisciplinary setting including professionals in PT, Otology, Neurology, and Optometry. Several case reports will be presented to assist in comprehensive understanding of the entire process. An extensive reference list will be provided to assist in continued learning


Course Objectives:

1-Understand the neuroanatomy and function of the systems directing and influencing spatial orientation, balance and righting responses, and oculomotor control.

2-Interview, analyze intake forms and inventories, and critically review past medical history to determine the most salient data that guides the evaluation, diagnostic, and intervention processes. 3-Differentially diagnose the conditions that cause or contribute to dizziness and balance disorders such as Vestibular Neuritis, BPPV, Endolymphatic Hydrops/Meniere’s Disease, Migraine Associative Dizziness, Concussion, Vestibular Toxicity, Dysautonomia/Postural Orthostatic Hypotension, Tumors, Fistulas, Oculomotor/Visual Dysfunction, Cervical/Somatosensory Dysfunction, Anxiety, Chronic Subjective Dizziness, and other Central Vestibular Disorders.

4-Consider the categories of dysfunction in the diagnostic process, to guide the selection of tests and measures, and provide a clear PT evaluation. 

5-Understand and select the relevant outcome measures for goal setting. 

6-Design and prescribe a customized intervention program utilizing the critically analyzed data, and considering patient tolerance, resources, equipment available, and outcome measures selected.


Concussion Session Objectives

1-Provide Sports Related Concussion evidence for baseline measures, sideline screening, removal from play, Second Impact Syndrome, and timing of early intervention.

2-Understand how relevant PMH, co-morbidities, and initial symptoms aide in predicting the course of recovery.

3-Categorize common subtypes of metabolic concussive injury, and classification of the symptom subtypes to guide evaluation and intervention.

4-Describe Return to Learn for students, and communicate effectively with medical team members, school administrators, teachers, and parents to offer optimal support for concussed youth.

5-Describe and prescribe Return to Play protocols using current evidence and considering the necessary integration of vestibular, visual and cognitive loading.

6-Undertand, measure, and monitor exertion tolerance.



This is a 16-hour course, equivalent to 16 CEUs.



Julie is a Board Certified Neurologic Clinical Specialist, and is Vestibular and Concussion ImPACT Certified. She is recognized as an expert in the area of vestibular rehabilitation and concussion recovery by her peers in Physical Therapy and Medicine. She began clinical practice in 1992 in Denver, Colorado at Saint Joseph Hospital, going into private practice in 1995. She was co-owner of South Valley Physical Therapy for 20years, and is currently the owner of NeuroBalance Physical Therapy in Castle Rock, CO. Julie is the Physical Therapy Consultant in concussion for the Denver Broncos Football Club, and Director of the Resilience Code Concussion and Neuroperformance Program in Englewood Colorado. She also consults for Team USA in difficult cases of concussed athletes with vestibular dysfunction. Julie has worked with professional athletes from the NHL, NFL, MLB, UFC, and elite distance runners. Julie has specialized experience over 25 years in the treatment of dizziness and balance disorders, post concussive syndrome, multiple sclerosis, movement disorders including Parkinsons and dystonia, brain injury, and facial disorders. She was a member of the interdisciplinary team of the Rocky Mountain Dizziness and Balance Center for 15 years. She worked with the Colorado Neurologic Institute’s Deep Brain Stimulator Program and developed the Physical Therapy examination protocol for patients pre and post DBS placement. She was elected to participate as a member of United Healthcare/Optum Health’s Physical Therapy Advisory Council for 3 years. Her special interest is in

neuroplasticity, neuroperformance in professional athletes, and concussion recovery in youth and adults. Julie is a member of the APTA Neurology Section, the Vestibular Special Interest Group, and the Vestibular Disorders Association, and actively reviews the literature in this area. She teaches seminars across the US on vestibular rehabilitation, and has been an invited speaker at over 40 conferences. She has been awarded the Outstanding Physical Therapist of the Year and the Bob Doctor Service Award by the Colorado American Physical Therapy Association.





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