Complex vestibular service - video transcript

BERNARD WHITFIELD:
My name is Associate Professor Bernard Whitfield. I'm head of the Integrated Specialist ENT service at Logan Hospital. The ENT service incorporates allied health disciplines of speech pathology, audiology and vestibular physiotherapy. The complex vestibular service at Logan comprises of three components. Dial-A-Dizzy, which is essentially a remote diagnostic tool for emerging vertigo presentations in rural and regional hospitals. Behind me is the Vertec immersive virtual reality balance assessor, together with balance retraining for all components of balance disorders.

Third component of the complex vestibular service is the TRV chair, which enables repositioning of trapped crystals within the semi circuit canals within the inner ear, which are responsible for detecting head movement.

LEIA BARNES:
Chris is a young man who has a young family and he's traveling around Australia, so it's packed everything up. They had this great journey planned. They've got these small young kids. He has also recently had cochlear implant surgery where when that's switched off, he's actually profoundly deaf and he can't actually hear anything. And that makes it really hard to communicate when he's feeling unwell because he solely relies on lip reading.

And when he felt so awful, he was shutting his eyes as well.

Chris, can you tell us your Dizzy story? Tell us about being admitted to Longreach Hospital and the feelings you had with your story.

CHRIS:
We started our trip in the van around Australia. Two days in, in the morning I felt really dizzy and then that afternoon nighttime everything was spinning. And then my wife called 000 and I ended up in Longreach hospital.

LEIA:
Chris felt so awful that he was in the late hours of the night he started to get he was struck with vertigo. His wife was alone with the kids and they had to call an ambulance. The ambulance had to come find them. And then they presented to the local hospital, which was Longreach Hospital.

STEPH:
When I first got in the next day, they mentioned that they were flying him out to Rockhampton because they were unaware of what his diagnosis was. There was a few things thrown around the room of what it could possibly be, which was very scary. But yeah, once we found the service it was amazing because when they first mentioned that they were going to fly to Rockhampton, I thought, Oh my god, I have to pack up the caravan, the kids. I have to drive over there.

That changes our trip, you know, what was our next spot from there? Are they going to take him back to Brisbane and things like that. So yeah, we, when we found out about the service, super thankful that we could get organized on the spot like get the right care plan in place and get back on the road.

LEIA:
So Dial-A-Dizzy came about where Dr. Whitfield and I, who's the head of ENT for a little while we've been talking about how good it would be to be able to assist the rural and remote doctors who are having people present with vertigo in tiny little hospitals all across Queensland. And how can we assist them or how can we do it better?

And we coined that as a first sort of thought bubble. And then one day I'm actually sitting in my clinic room and I can hear down the corridor going, Leah, Leah. And it's Bernie walking down the corridor with his phone going, Someone wants our hotline. And so as a result, we basically did a face time call, very low tech of someone who is in ED at Cooktown Hospital who had vertigo and the doctors there weren't sure what to do in terms of what were the best assessments and so forth.

So we actually took the patient then and there through the assessment and we identified that it was an inner ear, which is a really non-threatening, non worrying complaint and it’s specifically called benign paroxysmal positional vertigo. So BPPV and it can usually be treated in one maneuver. And I was able to then talk the doctor through this maneuver and the patient was able to go home and that was our thought bubble.

This was this could actually work. We should actually do this more. From there we were given some startup money so some project funding to actually pilot Dial-A-Dizzy. And just recently, just last week, we were able to find out that our local health service, Metro South Health, has actually supported us to do another 12 months of Dial-A-Dizzy.

STEPH:
Yeah, it was amazing that such a small piece of equipment. Yeah, and a bit of internet, what it can do to pretty awesome cheers and obviously you on the other end so.

LEIA:
I was going to say that! The equipment and that's exactly right. All we need is we need a little bit of goggles, a little bit of Internet and a little bit of experience in the area. And we can be able to help many, many people no matter where they live. And that's what Dial-A-Dizzy is all about.

JACINTA:
So this is the virtual reality and balance clinic. So it's the first public clinic of its kind in the Southern Hemisphere, actually, and we use it for both really gold standard, high level balance assessment. And then we can also use it for treatment of balance and vertigo and dizziness. Longer term, we see patients in this clinic with chronic dizziness, visually induced dizziness, imbalance and falls from a range of different conditions.

SHAUN:
I got injured in 2020 doing training for roller derby. We were doing contact drills and what was happening is every time I was coming in to contact another player, unfortunately I was leading with my head. I ended up with severe concussion and found out that I had other issues like with balance and whatnot and the damage as well.

JACINTA:
The machine has computerised dynamic posturography, which is just a big fancy word, and it means that the platform has a force plate embedded into the floor and it's dynamic so that it moves and responds to their body sway as they're doing certain balance challenges. So part of that force plate is that it actually measures the degree of body sway during those tasks, and it compares that to age and gender match norms.

But each different task that we get them to do and actually then tells us which balance system for them is impaired, to what level. So that then as therapists, we know how to target the rehab as, as kind of individualised as possible to their impairments. Do you think you can reach your hand up to each of the light posts, the lamp post and follow it around to the side?

Yes. So you have to whip your head around quickly to get back in time.

SHAUN:
I'm a full time carer for my grandson. My grandson suffers with cerebral palsy, and ocular vision impairment. It was really hard at times. My fatigue factor was going through the roof because you know, the pain and everything else was taking a toll on me. Once I started this treatment, it started to help in regards to learning to watch my positioning, bending down and everything with him picking him up.

And it has improved so much it's made things a lot easier. Yeah. Considering, yeah, for nearly 12 months it was a really struggle just to get out of bed in the morning, you know, just to do simple things. Now I feel that, you know, I'm back to where I was. Yeah. Prior to the head trauma.

JACINTA:
Shaun has been such a pleasure to work with in general. When we first tried, he's come from a lot of other therapists. He went to the brain injury unit. He did some therapy, vestibular rehab with our other team in the ear, nose & throat department. And I knew already about some of your impairments. So we started with only two lots of 2 minutes, 4 minutes total, and that was all that we could really manage in that first session.

And then by the end of the six sessions you were doing up to 20 minutes, sometimes a little bit more, and all the flow of all the different kind of visual stimulus, the force plate was on its maximum settings and with some foam as well. So he was really as hard as I could push him on that machine.

Then that was applying to everyday life and being able to manage all the things that you need to manage for sport but also for your care needs for your grandson. And the good thing is that it's here 20 minutes, 5 minutes, you know, a small amount of time here then is applying to everyday life and it's kind of sustained through throughout the week.

SHAUN:
When I was struggling with it. I lacked a lot of, you know, self-confidence and this is certainly helped me so much.

JACINTA:
So I think we're seeing some really beautiful and impactful changes to people's physical outcomes in terms of their balance and mobility and doing everyday tasks, but also their confidence. And you know, that side of things, anxiety, we’re taking all these other subjective kind of outcomes and making people feel better in themselves and feel better with their movement. So it feels very holistic in terms of the way that it improves and what could be better than that as therapy. It shouldn't be just physical only. I want people to leave feeling better in general.

SHAUN:
Yeah, and I certainly do.

JACINTA:
Good!

ETHAN:
Ok once more into the abyss. Do you want your glasses off and put your stuff on the desk?

So this is a multi axial repositioning chair. Patients that are in the chair have a condition called BPPV or they have positional dizziness. When they lie down or sit up or roll over in bed, they have typically experienced seconds worth of dizziness that last maximum about a minute or so. You experience dizziness, nausea and sometimes even vomiting when you lie down or change position.

So when you bend forward or look up at the roof or roll over in bed or sit up in the morning, you can get any of those symptoms. Patients that have BPPV are more likely to fall. So there's an increased risk of falling, breaking hips, coming into hospital for those reasons. Treatment and assessment is positional. So patients sitting in the chair, they got straps across their shoulders, across their hips and they'll be in the chair. We lie them down on their back.

And then we observe how their eyes move. Because particular directions of movements of the eyes indicate where the crystal or where the BPPV. And then we’re going to roll to this right side ok? Your inner ear helps to detect movement. So when you're moving around, it actually tells you where you are in space and you've got one on your left side and one in your right side, which is why when we're doing the testing, we can turn your head to the left to test your left side and turn your head to the right, to test your right side. In a normal inner ear, when you lie down, it should be just, there should be a small amount of fluidmoving.

But for people that have these crystals, these BPPVs in the wrong spot, they cause extra fluid to move. So when you do lie down rather than the normal amount of fluid moving, extra fluid moves and your brain gets the false sensation that you're actually moving when you’re not.

Alright we’re coming back on to your back Brad.

BRAD:
Probably 10 years ago I did have a similar sort of thing and I was put in the chair and and spun up just a normal like a barber's chair. And the ENT specialist just moved my head, moved my head and then sat up. He said, right, you're done. I went, okay. And it worked. But it did come back and then I just went, well ok, I can't do much else with that. That's how it's going to be. So I never worried about it for years. And then yeah, coming here, it's just he just sat me down and off we went. It was, it was really good. It was fantastic.

ETHAN:
Patients when they’re here the first day, because being dizzy causes a lot of symptoms, they feel nauseous and they feel like they're quite sick. They'll go through the treatment. They go, ‘Oh yuck, that was a bit gross’. And then they come back the next time and they're skipping in or they're like ‘I’m fixed’! Like, ‘I'm good again’. So as a physician, I kind of make it through the first session and go, You're going to feel it.

You might feel a bit dizzy with this, you might feel a bit unwell. And then I'm waiting for the second session to come back and they're happy. And they’re smiling, they’re shaking your hand. And they want to give you a hug and you ‘re like ’no, we've got COVID. Let's just still stay aparts’. The second session is really quite rewarding.

BRAD:
Yeah, yeah. And that was no trouble at all. It was great.

ETHAN:
No, and that's the thing. Like you’re obviously not doing this treatment every day. The research says that this chair is more effective at treating patients. So rather than having them do that, that equi maneuver over the edge of a bed and turn and roll and sit up. If you can do this once and fix people, it's much better than putting you through doing multiple treatment sessions over a lot of time.

So much more effective in the in the grand scheme of things, right?

BRAD:
Yeah. This is it's really good. Really good.

BERNARD:
For more information, please visit the Clinical Excellence Showcase website. And with regards to the Dial-A-Dizzy program, it's 13 400 DIZZY.