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How to get the most out of your telehealth vestibular evaluation

Updated: Sep 22, 2020

This video is about what to expect from a telehealth vestibular evaluation with DizzyPhysio. Rudie walks through the evaluation process from beginning to end, including some useful techniques and tips for some of the assessment process. You can see how to fill out the intake forms, how to access the videoconference, how to hold or set up your camera, and a few things your therapist may have you do. PLEASE watch this video before your telehealth evaluation!



Breakdown:

0:40 - Intake Paperwork

1:41 - How to connect to your virtual meeting using Teams on a computer

2:13 - How to connect to your virtual meeting using Teams on a mobile device

2:55 - Other tips for a smooth virtual visit

3:50 - What kinds of questions will be asked

4:40 - Tips for performing the tests

6:22 - Examples of different tests

6:52 - Balance

7:31 - Camera Placement

9:22 - Walking balance

10:42 - Eye movement

12:22 - What comes next?


Transcript:

Hi! I’m Dr Rudie Spigarelli. You may be wondering what to expect from a telehealth vestibular exam with me, and how you can make the most of it so that it runs smoothly and provides as much information as possible. In this video I’m going to walk you through the whole process, from beginning to end, and throw in some tips and tricks throughout. You can pause and replay this video as many times as you’d like to feel comfortable. So let’s get started.

When you book your appointment on the DizzyPhysio website, you’ll receive an email with links to our intake paperwork. This will include questions about your current problem, past medical history, consent to receive care, and confirmation of who you are. Fill this out as completely as you can. The sooner, the better. This may seem like a lot of questions, but it will help give your clinician the information they need to make decisions about your care, and save a lot of time during your exam. Believe it or not, the most valuable information we gather will come from your description of what you are experiencing, including when the symptoms started, and what makes it better or worse. If you’re not sure, don’t worry. We can help tease out more information later. You’re done with this once you see the screen thanking you for completing the form.

The email you received when you booked your appointment will also have a link to your video meeting with your clinician. It’s a good idea to connect ahead to time to make sure your camera and microphone are working. Clicking the link should open a window in your internet browser to our virtual waiting room. Here you can test your camera and microphone to make sure it works. You may have to give it permission to access your camera and microphone. If you’re planning your visit on a mobile device, such as a cell phone or a tablet, you’ll have to have the Microsoft Teams app, which is free. You can get this through your app store, or by clicking the “Join the Teams Meeting” link from your appointment email using your mobile device and following the instructions. You DO NOT need a Teams account to use this service, so you’ll end up choosing “Join through the web”, or “join as a guest” to connect to your meeting, and typing in your preferred name. I recommend using a mobile device, especially for the first evaluation visit. This is so that you can point and move the camera around. This isn’t a requirement but makes the assessment much easier for reasons we will talk about in a moment. Some other tips are to make sure that you have a strong internet connection. Closing all the other tabs and windows on your device will help with this, as well as making sure no one else in your family is using the internet at the same time, such as for things like streaming movies or music, or having their own telehealth visit! This takes up bandwidth, which may be needed for your appointment. When it is time for your appointment, your clinician will connect with you from the virtual waiting room, and your visit has begun!

First, we will start by asking questions about your symptoms and goals. These questions may seem pretty detailed, such as when they started, how have they changed over time, how are they affecting your everyday life, what have you tried so far, what makes it worse or better. One common question is “if you could describe your dizziness, how would you describe it, without using the word ‘dizzy’?” These questions will be specific to your problem and situation, because everybody is different in how they experience and respond to dizziness and pain, and our experts are experienced in getting to the bottom of your symptoms.

Next your therapist will proceed to walking you through some tests. Our clinicians explain the whole way what they are doing and why. Many of these tests involve watching your eye movement. This is because of the close connections between your eyes, your inner ear, and your brain, and we can tell a lot about your problems based on how your eyes move. The assessment will likely also involve looking at your balance while holding still and while walking. This is why it is helpful to have a mobile device when performing this assessment, so that you can hold it close to your eyes, or set it on something. One trick is to have more than one device connected during your telehealth visit, such as a mobile device and a computer for more mobility and options during your assessment. You can connect as many devices through the link in your email as you wish, and your clinician can help direct this. It’s also recommended to have someone else with you, such as a friend or family member, so that they can help you with holding the camera and getting into some of the positions. Some of these tests may involve making you feel your symptoms in order to learn more about them. But don’t worry. We try to minimize discomfort as much as possible, and will not have you do anything dangerous. Communicate! And let your clinician know if you feel unsure of anything.

We’re going to talk now about some of the specific recommendations for different testing and assessment your clinician may do with you. These are just recommendations, and you may need to modify what you do based on your available resources and mobility. That is fine! We are flexible and persistent. We don’t give up easily, and neither should you! Patience is very important when it comes to telehealth visits.

For assessing balance, it is important to have something nearby to hold onto, such as a countertop or the back of a sofa, something sturdy that won’t tip over. Or you could try standing with your back to a corner so that a wall or structure is there to support you if needed. Sometimes closing a door is the best way to find an open corner in your house. Your clinician needs to be able to see most of your body, or all of it if possible. Position the camera just far enough away to see as much of your legs and shoulders as possible. Your clinician may wish to see different angles. Try some places in your house you think would be appropriate and safe for this assessment, ahead of time, and see if the camera location is right for you. The clinician will assess how long you can hold different standing positions, each position isolating a different part of your balance for assessment.

This goes for positioning the camera for walking, too. Your clinician may want to see a side-angle, and a forward angle. If walking is particularly hard for you, or you’ve had falls in the past, consider aiming the camera down a hallway so that, if you need to, you can grab a wall. The therapist will ask you to do a number of laps, possibly with different tasks to see how your balance and gait respond.

For assessing eye movement, you may want to have something beyond the camera to focus your eyes on, while the camera watches your eyes closely. On an iPhone, the camera is located at the top of the screen, in a tiny circle. That is where you will want to line up your eyes for best visibility.

Your therapist may ask you to follow a target with your eyes, or move your head and maintain focus. One of the most common forms of vertigo involves close assessment of your eye movement with your head in different positions against gravity. For this, you may prefer to attain these positions by lying on your own bed. You will need to use pillows to help achieve just the right head position. This is where it is particularly helpful to have someone helping you hold the camera close to your eyes, but you could hold the camera yourself if you had to. Just try to look beyond the camera, and line up the camera with your eyes. If this provokes vertigo, it can be very scary, but it is important that your clinician can observe your eye movements during these moments. Again, your clinician will explain everything thoroughly before proceeding.

Once your assessment is complete, your clinician will determine what sort of treatment is best for you, and will discuss it with you thoroughly, answering any questions you may have. If there’s time, you will be given exercises to start on right away. These exercises often make people feel dizzy or unsteady initially, so monitor how you feel before and after doing them, and also how you feel day to day. Of course, safety first is ALWAYS rule number one. Make sure you are in a safe environment, and let your therapist know of any concerns you may have.

Depending on your problem and goals, your clinician will recommend a number of follow-up visits to review these exercises, add to them, make them harder or easier, and gradually work towards getting you back to normal. You can purchase the recommended number of visits on our website, DizzyPhysio.com. I hope that this video has been helpful in getting you ready for your telehealth therapy visit. Thank you for watching! You are going to be so ahead of the game and efficient after watching this video, and knowing how to set things up ahead of your appointment. It is in the nature of telehealth to require a lot more active participation on the part of the patient, which I think is a great thing, and you are off to a great start! Best of luck with your upcoming appointment!

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