Vestibular Rehab Blog Series: 2 of 12
How important is the subjective report? Well, the literature suggests that greater than 80 percent of information needed to identify the potential etiology of symptoms is made during the patient interview. An accurate diagnosis depends on a comprehensive intake, which is reviewing past medical history, identification of potential risk factors (even red flags are possible factors that would delay recovery), and categorizing symptoms. Let's take a look at patient history. The four characteristics we're going be discussing are:
- The quality of dizziness - such as What are your symptoms?
- The timing and duration - When did it happen?
- What were the triggering circumstances - What were you doing?
- And what are other associated symptoms? For example, with or without hearing loss?
First, let's break down quality of dizziness. Dizziness is what we consider an umbrella term. It's very vague. It means a lot of different things to a lot of different people. Now sometimes you'll see where the quality of dizziness is broken down into three categories which are vertigo, feeling lightheaded, and or unsteady. Let's start with vertigo. Here, you want to ask, is the room spinning or is it a spinning sensation inside your head? For lightheadedness, you want to ask about blood pressure, blood sugar, could there potentially be a component of anxiety? And for unsteadiness asking them, is it more of a feeling in your feet? Or do you feel drunk-like?
Certainly, there's going to be patients that have been in your clinic or will come into your clinic and the diagnosis is vertigo. We start the patient interview by asking, ‘is the room spinning?’ And they're respond by saying, ‘no, the room is not spinning. I just feel like I'm walking on a cloud or I just feel faint-like.’ So oftentimes you'll ask a question and their response is almost putting them into one or more of these categories.
Now, let's look at timing and duration: on-set, frequency, and length. Was this sudden or has it been a gradual onset? And what's the frequency? Does it occur in spells or episodes? Is it constant? And what about the length? Is it seconds, minutes, hours, days?
Next, let's talk about triggering activities. So, at the onset, did it start when you were rolling over in bed or lying down, standing up with stress and illness or allergies, medications, trauma? And I think it's probably a pretty safe bet by me just mentioning these things, you are already thinking about a potential diagnosis by taking clues from the history and starting to create a working diagnosis. What about exacerbating triggers? Oftentimes with dizziness, we find ourselves a little bit more hesitant to kind of dive in and ask questions. Particularly as therapists feel so much more comfortable talking about pain. You're asking what makes it worse, what makes it better? Dizziness is no different. We're going to approach it the same way. So, is it exacerbated by position changes, moving your head, looking at a computer screen for a long time? Busy places, loud noises, and we also want to know what makes it feel better. Does being still? Does movement? Does rest? Medications? Is there another relieving factor?
Moving on to associated symptoms, certainly we could have plenty of categories here. I'm going to talk about two and then kind of leave that third category open under other. When it comes to dizziness, we really want to look at otologic symptoms or symptoms related to the ear. So, is it with or without hearing loss? Does the patient have tinnitus? Do they have oral pressure, which is pressure in your ears? Are there central signs? Do they have double vision with a dysarthria? Weakness in their arms or legs? And certainly there's a plethora that could fall under other, more commonly related to dizziness would be nausea, fatigue, foggy headedness, anxiety, just to name a few.
You could also consider a symptom log for your patients, something you want to send them home with, particularly if you're going to see them again or if you think you might refer them to another provider. It would give them a way to categorize their symptoms on their own. This is just a snapshot of symptoms log that we actually modified from the Vestibular Disorders Association and provide you for a handout. They can write the date. This is where we talk about the four characteristics I just mentioned, the quality, the duration, the triggers and the associated symptoms.
Click here to progress to the next blog in this series: Clues from the History