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Patient care

Patient care

Curious About How Sleep Works?

Do you hear that buzzing? No, it is not tinnitus. It is the alarm clock attempting to rouse you out of bed. Hopefully, you woke up having had a good night of sleep.

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Ask the Expert: Concussion

Ask the Expert: Concussion

Physical Therapist: Shelly Massingale, PT, MPT

1. Concussion has received significant media attention over the last few years. What is a concussion? 

The CDC defines concussion as “a type of traumatic brain injury or TBI- caused by a bump, blow or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth.”  Concussion is commonly referred to as a mild traumatic brain injury (mTBI) and is typically associated with normal structural imaging (normal CT/MRI). Symptoms of concussion  can include dizziness, headache, cognitive changes, mood changes, balance problems, and nausea and vary from person to person and from injury to injury.  Concussion is considered a transient injury that typically lasts a few days to a several weeks before full recovery.  

2. Dizziness and balance problems are common after concussion. Why are these symptoms so common?

Dizziness and balance problems that occur after a head injury are often the result of damage to either the peripheral or central vestibular system.  Our vestibular system is comprised of our inner ear (peripheral vestibular system), the vestibular nerve (connects the peripheral to the central vestibular system), and the areas in the brain that process that information (central vestibular system).  If any of these areas have been affected, the injured person could experience feelings of dizziness, being off balance, vertigo or a combination of these.  Our vestibular system is highly sensitive to movement, so any damage or disturbance to these areas cause symptoms while performing activities of daily living. 

3. Do you recommend that patients pursue vestibular rehabilitation after a concussion?

If a patient sustains a concussion and has any symptoms of dizziness, vertigo, imbalance, or nausea that last more than a few days, I highly recommend pursuing vestibular therapy. Vestibular therapy an effective treatment, and having a specialist take you through a course of treatment will allow you to recover more quickly. The patient’s physician typically makes the initial referral to vestibular therapy after a thorough medical evaluation of concussion.

4. If so, what vestibular rehabilitation techniques help to reduce symptoms and improve function?

The technique used in vestibular therapy depends on the nature and severity of the symptoms, as well as the underlying cause. When someone sustains a concussion, symptoms of vertigo may occur with positional changes. This diagnosis is called Benign Paroxysmal Positional Vertigo (BPPV), which commonly occurs after head injury. The treatment for BPPV is very specific and should be performed by a trained clinician. If BPPV is not present, then balance exercises and vision retraining exercises that address how the head and eyes move together are very effective in reducing dizziness and imbalance. Exercises selected are highly specialized and very specific to the individual’s symptoms and daily activity demands, and should only be performed by a clinician that has training in this type of therapy.

5. Are there specific exercises or strategies most helpful for improving symptoms after concussion?

See above answer 4.

6. Do you recommend vestibular rehabilitation for all patients post-concussion? Are there patients with certain symptoms who benefit most?

Vestibular therapy is not indicated for every patient who sustains a concussion.  Some people will be diagnosed with a concussion and will not have any symptoms related to dizziness, imbalance or vertigo. These patients do not need to participate in vestibular therapy.  On the other hand, any person who is experiencing dizziness, vertigo, and/or imbalance after sustaining a concussion would likely benefit from participating in vestibular therapy, especially if the symptoms persist for more than a few days. 

7. I’ve had quite a bit of neck pain and stiffness after a car accident. Could this be the cause of my dizziness?

Cervicogenic dizziness can occur with a whiplash injury and is often diagnosed with concussion. Cervicogenic dizziness is defined as the presence of dizziness, imbalance or unsteadiness related to movements or position of the cervical spine or related to a stiff or painful neck. The treatment for cervicogenic dizziness is therapy for the neck to help decrease the discomfort and stiffness. Reducing stiffness and muscle imbalance in the neck can help to decrease the sensation of dizziness.

8. Are there any screening measures or tests available that you’d find helpful to have prior to seeing a patient referred for VRT? 

Prior to starting VRT, a patient should be evaluated by a physician with specialized knowledge about concussion and brain injury. A concussion can cause a myriad of symptoms in addition to dizziness/imbalance, so a thorough and complete assessment of post-concussion symptoms is necessary to determine the correct course of treatment for each individual. Depending on the severity of the injury and the symptoms, an audiology evaluation may be helpful to more thoroughly assess inner ear function.  The physician overseeing the case usually determines which clinical tests need to be performed prior to initiating vestibular therapy.

9. What would you want the general public to know about concussion rehabilitation? 

Concussion rehabilitation is most effective and efficient when the patient receives a multidisciplinary evaluation and individualized approach to care. Concussion is a complex injury which should not be addressed using a “cookie cutter” approach to treatment and focusing on treatment of only one aspect of concussion may lead to a longer recovery.  

10. What is your overall key take home message for providers working with patients with suspected post-concussion dizziness? 

I would highly recommend that the provider working with post-concussion dizziness complete specialized training that addresses the nature of concussion/brain injury and reviews appropriate treatment protocols. I cannot stress enough the importance of having a multidisciplinary team of clinicians overseeing the treatment, management and rehabilitation of patients to ensure the patient is receiving the best care for his or her injury.   

 

Shelly Massingale is the senior director of Banner Concussion Services in Arizona and Colorado. She is a physical therapist and has been a specialist in vestibular and balance therapy for the past 22 years. Shelly has focused her treatment and research primarily in mild traumatic brain injury since 2013 and has lectured nationally and internationally on evaluation and treatment of vestibular and balance deficits related to mild traumatic brain injury. 

The Medicare Audiologist Access and Services Act

The Medicare Audiologist Access and Services Act

Issue Brief

Representatives Tom Rice (R-SC), Matt Cartwright (D-PA), Mark Meadows (R-NC), Ralph Norman (R-SC), Mike Kelly (R-PA), Jan Shakowsky (D-IL), Brad Schneider (D-IL), Ann Kuster (D-NH), Gus Bilirakis (R-FL), and Lisa Blunt-Rochester (D-DE) introduced H.R. 4056 on July 25, 2019. This legislation has been endorsed by the American Academy of Audiology, the American Speech-Language-Hearing Association, the Academy of Doctors of Audiology and the Hearing Loss Association of America. On September 9, 2019, U.S. Senators Elizabeth Warren (D-MA), Rand Paul (R-KY), Sherrod Brown (D-OH), and Roger F. Wicker (R-MS) introduced an identical companion bill in the Senate (S. 2446).

Medicare already covers a range of hearing health services, and audiologists are trained and licensed in all fifty states and the District of Columbia to perform these services. However, Medicare currently does not recognize audiologists as providers of most hearing-related services and will only allow reimbursement for a narrow set of tests to diagnose a hearing or balance disorder—and only if patients first obtain an order from a physician. Medicare’s rules are far more restrictive than many private and federal insurance plans. The Medicare Audiologist Access and Services Act ensures that Medicare beneficiaries have access to a full range of hearing and balance health care services provided by licensed audiologists. The bill:

  • Amends the definition of “audiology services” in the Medicare statute, which specifies the services that audiologists may provide, to include all services already covered by Medicare that are also within an audiologist’s scope of practice.
  • Amends the Medicare definition of “practitioner” to include audiologists, which improves beneficiary access to audiologic and vestibular care, a change that is consistent with Medicare’s classification of similar health care providers such as clinical social workers and clinical psychologists. 
  • Makes technical changes to the classification of audiology services in the Medicare system as “other diagnostic tests” to remove the pre-treatment order requirement, which does not exist with any other federal or commercial payer; and
  • Makes no change to the scope of hearing health benefits covered by Medicare or the scope of practice of audiologists.

View Issue Brief (PDF) | View Press Release (PDF) 

JAAA Editorial: The American Academy of Audiology Honors Committee: A Mechanism to Acknowledge Those in Audiology Who Have Gone Above and Beyond in Their Contribution to the Profession


Access JAAA online

Volume 30, Number 7,
July/August 2019

Patricia Gaffney, AuD  Chair, Academy Honors Committee
Devin L. McCaslin, PhD 
• Deputy Editor, Journal of the American Academy of Audiology

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Take Stock of Your Office

Best practices in audiology recommend defining set protocols and procedures for patient care and follow up. We have many resources to pull from for this guidance in our audiology organizations, in the current evidence-based literature, as well as our state and local legislative and licensure guidelines.

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PUBLIC RELATIONS | Reach Your Ideal Patient and Stay in Touch

There are many companies that target potential customers by basing their reach on their current customers. While that is an effective way to know that you’re reaching prospects, you may not be reaching the customers you want and your ideal audience/customer may still be out there.

Topic(s): Marketing, Public Awareness, Patient care

Author(s): 

Publication Issue: Audiology Today July/August 2019

CSI: Audiology Image

CSI AUDIOLOGY | Considering Birth History When It Comes to High-Frequency Hearing

Case History

The 26-year-old mother was healthy throughout the term of the pregnancy and went into labor at 40-weeks' gestation. The pregnancy was complicated just prior to delivery with a possible abruption. There was significant bradycardia with the heart rate of the patient down to 40 beats per minute prior to delivery. This required a stat cesarean section.

Topic(s): Hearing Loss, High Frequency, Balance/Vestibular, Patient care

Feature 1: Story image

Maximize Children’s School Outcomes: The Audiologist’s Responsibility

For children with hearing loss to succeed in school, good access to classroom information is absolutely essential. Acoustic accessibility means that the child’s technology and classroom acoustics need to be monitored, educational staff need to understand the effect of hearing loss on the reception of academic and social information, and teachers need to know how to employ useful classroom modifications. If there is no educational audiologist to advocate for the child, someone else needs to pick up the slack. 

Topic(s): Pediatric, Hearing, Patient care

CSI: Audiology Image

CSI AUDIOLOGY | When Is Ménière’s Disease Not Ménière’s Disease?

Dizziness is a common complaint, with approximately 35 percent of adults reporting dizziness, with the prevalence increasing dramatically with age (Agrawal, 2009). As the profession of audiology has evolved, so has our understanding of the various disorders that cause imbalance and dizziness. This article will walk you through the case of Sunny Susan (patient’s name changed to protect identity), a woman who I first saw as a balance patient after she had spent over 22 years struggling with recurrent dizziness and progressive hearing loss. 

Topic(s): Dizziness, Balance/Vestibular, Meniere’s Disease (MD), conductive-mixed hearing loss, Hearing Loss, Tinnitus, Patient care

Author(s): 

Publication Issue: Audiology Today March/April 2018

Audiology Today Mar/Apr 2019…What’s Inside This Issue?

The editorial team and I are so happy to announce the content for this latest issue of Audiology Today. We are featuring a number of comprehensive, relevant, and interesting articles, as well as some short reads on public relations, coding and reimbursement, and audiology advocacy.

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