Specific criteria have been developed based on computerized dynamic posturography (CDP) to assist clinicians in identifying patients with psychogenic balance problems (Cyr and Cevette, 1993; Cevette et al., 1995; Goebel et al., 1997; Gianoli et al., 2000). Patients with known spinocerebellar ataxia (SCA) meet several of the criteria for psychogenic balance problem and risk being misclassified as having imbalance of psychogenic origin. However, our research shows that patients with SCA may be distinguished from patients with psychogenic balance problems in several ways. We compared test performance on CDP and the observation of specific behaviors that are associated with psychogenic balance problems in patients with SCA (n = 43) and patients with known psychogenic balance problems (n = 40). Chi-square analysis was used to determine if there were significant differences between the groups for the frequency of each criterion for psychogenic CDP and Observed Behaviors. Level of significance was Bonferroni corrected for multiple comparisons. Sensitivity, specificity, and positive likelihood ratios were calculated for each criterion. Hierarchical cluster analysis was used to examine whether the two patient groups demonstrated similar groupings of criteria. Comparison of the results of these analyses identified two criteria that were significantly more frequent in the psychogenic group than in the SCA group: regular periodicity of sway and circular sway. Sensitivity, specificity, and positive likelihood ratios identified two additional criteria, inconsistent motor responses and large lateral sway that also seem to suggest a psychogenic component to a person’s imbalance. Prospective studies are needed to validate the usefulness of these findings.

Background Unilateral peripheral vestibular loss results in gait and balance impairment, dizziness and oscillopsia. Vestibular rehabilitation benefits patients but optimal treatment remains unkown. Virtual reality is an emerging tool in rehabilitation and provides opportunities to improve both outcomes and patient satisfaction with treatment. The Nintendo Wii Fit Plus® (NWFP) is a low cost virtual reality system that challenges balance and provides visual and auditory feedback. It may augment the motor learning that is required to improve balance and gait, but no trials to date have investigated efficacy. Methods/Design In a single (assessor) blind, two centre randomised controlled superiority trial, 80 patients with unilateral peripheral vestibular loss will be randomised to either conventional or virtual reality based (NWFP) vestibular rehabilitation for 6 weeks. The primary outcome measure is gait speed (measured with three dimensional gait analysis). Secondary outcomes include computerised posturography, dynamic visual acuity, and validated questionnaires on dizziness, confidence and anxiety/depression. Outcome will be assessed post treatment (8 weeks) and at 6 months. Discussion Advances in the gaming industry have allowed mass production of highly sophisticated low cost virtual reality systems that incorporate technology previously not accessible to most therapists and patients. Importantly, they are not confined to rehabilitation departments, can be used at home and provide an accurate record of adherence to exercise. The benefits of providing augmented feedback, increasing intensity of exercise and accurately measuring adherence may improve conventional vestibular rehabilitation but efficacy must first be demonstrated.

Background and Purpose: The increasing complexity of medical care in the United States calls for providers to become leaders in various aspects of health care. Combining clinical skills with knowledge of public health and the business/administrative side of health care allows health care providers, including physical therapists, to effectively manage and navigate the changing health care environment and become leaders in their field. The purpose of this paper is to describe the method and process of successfully establishing dual degree programs in business and public health and in the physical therapist education program at Emory University. Method/Model Description and Evaluation: The process for institutional level agreements, curricular structure, admissions process, and graduation requirements for dual degree program students in the Doctor of Physical Therapy (DPT) and Master of Business Administration (MBA) or Master of Public Health (MPH) at Emory University is described in this paper. Additionally, 2 surveys were conducted: 1 survey of all students in 3 DPT classes (n = 201) and the other survey of dual degree program graduates as of 2013 (n = 8). The surveys evaluated student awareness of the dual degree programs during the DPT program application process and characteristics and perceptions related to the dual degree programs. Outcomes: Eighty-three percent of all students indicted that they were aware of the dual degree programs while applying to our DPT program and 6% indicated it was a key deciding factor in their decision to apply to our program. The graduating grade-point average (GPA) and first time pass rate on the National Physical Therapy Exam (NPTE) licensure of the dual degree students in the DPT program is at least equal to that of the overall DPT class graduating the same year. Moreover, 86% of dual degree program graduates indicated that it made them a more competitive job candidate. Discussion and Conclusion: In addition to fostering interprofessional education, the dual degree programs at Emory show positive outcomes, as all graduates indicated that their dual degree positively impacted their careers, and the majority reported specifically using their dual degree in their career. Also, the graduating GPA and first time pass rate on the NPTE of the dual degree students in the DPT program is at least equal to that of the overall DPT class graduating the same year, suggesting that the burden of an additional course of study was not adversely impacting their performance in the DPT program. At Emory University, the dual DPT/MBA and DPT/MPH programs have been designed to provide students with the necessary clinical, business, administrative, policy analysis, and public health perspectives required to excel as leaders in the future health care system.

This work reports the use of a head-motion monitoring system to record patient head movements while completing in-home exercises for vestibular rehabilitation therapy. Based upon a dual-axis gyroscope (yaw and pitch, ± 500-degrees/sec maximum), angular head rotations were measured and stored via an on-board memory card. The system enabled the clinician to document exercises at home. Several measurements were recorded in one patient with unilateral vestibular hypofunction: The total time of exercise for the week (118 minutes) was documented and compared with expected weekly exercise time (140 minutes). For gaze stabilization exercises, execution time of 60 sec was expected, and observed times ranged from 75-100 sec. An absence of rest periods between each exercise instead of the recommended one minute rest period was observed. Maximum yaw head velocities from approximately 100-350 degrees/sec were detected. A second subject provided feedback concerning the ease of use of the HAMMS device. This pilot study demonstrates, for the first time, the capability to capture the head-motion "signature" of a patient while completing vestibular rehabilitation exercises in the home and to extract exercise regime parameters and monitor patient adherence. This emerging technology has the potential to greatly improve rehabilitation outcomes for individuals completing in-home gaze stabilization exercises.