Mackenzie Vestibular study plan
Mackenzie Vestibular · Give each week a clear focus.
8 weeks · About 6 hours per week
Vestibular Anatomy and Physiology & Bedside Vestibular Examination (oculomotor, positional, head impulse testing)
Diagram the peripheral and central vestibular pathways, labeling receptors, ganglia, brainstem nuclei, and cortical projections, from memory.
Explain the functional role of each semicircular canal and otolith organ in detecting angular and linear acceleration.
Describe the vestibulo-ocular reflex (VOR) arc, including the three-neuron pathway and the role of velocity storage.
Perform and interpret a bedside oculomotor examination (saccades, smooth pursuit, optokinetic nystagmus, vergence) on a partner, documenting normal and abnormal findings.
Compare the physiologic basis of the head impulse test (excitatory vs. inhibitory phases) and demonstrate correct technique.
Your checkpoint
Record a 10-minute video of a complete bedside oculomotor and head impulse exam on a partner, with a written self-critique noting at least three technique refinements.
Vestibular Pathology and Differential Diagnosis & Bedside Vestibular Examination (oculomotor, positional, head impulse testing)
Differentiate peripheral from central vestibular pathology using at least six bedside findings (e.g., nystagmus direction, head impulse result, skew deviation).
Outline the clinical presentation and diagnostic criteria for vestibular neuritis, labyrinthitis, and Meniere's disease.
Explain the pathophysiology and red flags of posterior circulation stroke presenting with vertigo.
Perform and interpret the Dix-Hallpike and supine roll tests, distinguishing canal involvement.
Create a one-page bedside decision tree for acute vestibular syndrome that includes HINTS plus hearing.
Your checkpoint
Write a 500-word case analysis of a hypothetical acute vestibular syndrome patient, applying HINTS and justifying the final diagnosis.
Vestibular Laboratory Testing (VNG, vHIT, VEMP, rotary chair) & Vestibular Pathology and Differential Diagnosis
Describe the technical setup, patient instructions, and artifact recognition for videonystagmography (VNG) subtests.
Interpret caloric irrigation results using Jongkees' formula and identify unilateral weakness and directional preponderance.
Explain the principles of cervical and ocular VEMP testing, including electrode placement and expected waveforms.
Compare rotary chair testing paradigms (sinusoidal, step velocity) and their indications.
Correlate laboratory findings with clinical diagnoses for at least three case scenarios.
Your checkpoint
Complete a 20-question self-made quiz on VNG, VEMP, and rotary chair interpretation, scoring at least 85% and reviewing missed items.
Benign Paroxysmal Positional Vertigo and Canalith Repositioning & Vestibular Laboratory Testing (VNG, vHIT, VEMP, rotary chair)
Explain the canalithiasis and cupulolithiasis models for each affected canal.
Demonstrate the Epley, Semont, and Barbecue roll maneuvers with correct head positioning and timing.
Interpret video head impulse test (vHIT) gain values and recognize covert and overt saccades.
Differentiate vHIT findings in unilateral vestibular hypofunction, bilateral hypofunction, and central disorders.
Design a treatment algorithm for BPPV that includes canal identification, maneuver selection, and post-maneuver instructions.
Your checkpoint
Create a step-by-step illustrated guide (hand-drawn or digital) for all three canalith repositioning maneuvers, including patient instructions and precautions.
Vestibular Rehabilitation and Unilateral/Bilateral Hypofunction Management & Vestibular Anatomy and Physiology
Explain the mechanisms of vestibular compensation (adaptation, substitution, habituation) and their clinical implications.
Design a progressive vestibular rehabilitation program for a patient with unilateral hypofunction, including gaze stabilization and habituation exercises.
Adapt rehabilitation goals and exercises for a patient with bilateral hypofunction, emphasizing substitution strategies and safety.
Describe outcome measures (e.g., DHI, ABC, FGA) and how to use them to monitor progress.
Identify precautions and contraindications for vestibular rehabilitation in specific populations.
Your checkpoint
Write a 6-week home exercise program for a hypothetical patient with unilateral hypofunction, specifying exercise progression, frequency, and outcome measures.
Central Vestibular Disorders and Concussion-Related Dizziness & Vestibular Rehabilitation and Unilateral/Bilateral Hypofunction Management
Differentiate central vestibular disorders (e.g., vestibular migraine, cerebellar ataxia, vestibular schwannoma) based on history and examination.
Explain the pathophysiology and assessment of concussion-related dizziness, including cervical and ocular motor contributions.
Develop a return-to-activity progression for a concussed athlete with persistent dizziness.
Integrate central and peripheral findings into a comprehensive rehabilitation plan for a complex patient.
Describe the role of vestibular rehabilitation in central vestibular disorders and concussion.
Your checkpoint
Produce a two-page clinical pathway for concussion-related dizziness, covering assessment, rehabilitation, and return-to-play criteria.
Professional Practice, Safety, and Documentation & Vestibular Pathology and Differential Diagnosis & Central Vestibular Disorders and Concussion-Related Dizziness
Outline the legal and ethical responsibilities in vestibular practice, including informed consent, scope of practice, and reporting.
Identify safety considerations in the clinic and during testing (e.g., fall risk, infection control, equipment safety).
Write SOAP notes that accurately document examination findings, assessment, and plan for three different case types.
Explain reimbursement and coding basics for vestibular services.
Review and integrate red-flag recognition from domains 2 and 7 into documentation and referral practices.
Your checkpoint
Draft three complete SOAP notes for varied vestibular cases, each including appropriate red-flag screening and referral language.
Vestibular Anatomy and Physiology & Vestibular Pathology and Differential Diagnosis & Bedside Vestibular Examination (oculomotor, positional, head impulse testing) & Vestibular Laboratory Testing (VNG, vHIT, VEMP, rotary chair) & Benign Paroxysmal Positional Vertigo and Canalith Repositioning & Vestibular Rehabilitation and Unilateral/Bilateral Hypofunction Management & Central Vestibular Disorders and Concussion-Related Dizziness & Professional Practice, Safety, and Documentation
Synthesize key concepts from all domains into a one-page summary sheet per domain.
Complete a 100-question mock examination under timed conditions, scoring at least 80%.
Review all missed questions and create flashcards for weak areas.
Re-demonstrate the bedside examination and repositioning maneuvers to ensure retention.
Finalize a personal quick-reference guide for clinical practice.
Your checkpoint
Achieve a score of 80% or higher on a timed 100-question mock exam and submit a remediation plan for any domain scoring below 70%.
Milestones
Week 2: Correctly perform and interpret Dix-Hallpike and supine roll tests on a partner, with written documentation of findings.
Week 4: Score at least 85% on the VNG/VEMP/rotary chair quiz and correctly demonstrate all three BPPV repositioning maneuvers.
Week 6: Complete a comprehensive rehabilitation plan for a complex case, integrating peripheral and central findings.
Week 8: Pass the timed 100-question mock exam with a score of 80% or higher.