Jeffrey Hoder, PT, DPT

Central Vestibular Dysfunction as Related to concussion, CVA , and Brain Injury: Focal and Global Lesions

Dr. Hoder is an Associate Professor within the Doctor of Physical Therapy Program at Duke University, where his primary responsibilities are teaching adult neurologic rehabilitation and gait analysis content across the curriculum. He received both his DPT and MS degrees in Physical Therapy from the University of Medicine and Dentistry of New Jersey (UMDNJ)/ now a part of Rutgers University. Additionally, he received his clinical specialist board certification in Neurology through the American Board of Physical Therapy Specialties in 2003 and was recertified in 2013. Dr. Hoder has significant experience in neuro-rehabilitation that he obtained while working as a Neurologic Clinical Specialist at the Rusk Institute of New York University Medical Center and at the Kessler Institute in New Jersey. He has previously held faculty appointments at Emory University within the Division of Physical Therapy and at Virginia Commonwealth University within the Department of Neurology. At Duke, his clinical areas focus on the management of gait and balance issues for individuals with movement disorders and central vestibular dysfunction. He also supervises and coordinates DPT students for the Duke Health Inter-professional Education (IPE) Clinic within the Emergency Department. Additionally, he has been a faculty member for over 13 years in the “Vestibular Rehabilitation: A Competency-Based Course�, now co-sponsored by the Duke University Doctor of Physical Therapy Division and the APTA. He has lectured nationally and internationally on topics related to Movement Disorders and central vestibular dysfunction.

Session Description

Accurate information and interpretation of our vestibular input is essential to answering the questions of where am I going and which way is up. We utilize this information to keep our visual world in focus and to maintain control of our body in space. What if our peripheral vestibular sensory organs that sense movement are intact, but the parts of our brain that interpret this information are damaged? This 6-hour, one day course, designed for both the novice and experienced clinician, will cover the examination and management of central vestibular dysfunction. Participants will first review the neuroanatomy of the vestibular system, including sensory information sent to the spinal cord, cerebellum and cortex. Next, participants will review critical elements of the physical therapist examination to identify central vestibular dysfunction. We will review potential causes of central vestibular dysfunction with particular attention to comparing and contrasting focal and global lesions related to stroke and brain injury. Finally, through discussion of clinical cases, we will discuss prognosis for recovery and clinical rehabilitation management. This course promises to break down complex topics into knowledge and skills you will take back and utilize in your clinic on Monday morning!

Course Objectives

  1. To explain the role of the vestibular system with regards to perception of movement, gaze stability and postural control.
  2. To review and discuss the neuroanatomy of the peripheral vestibular system and its central projections to the spinal cord, cerebellum and cortex.
  3. To perform the critical elements of the physical therapist examination of the vestibular system with regards to gaze stability:
    1. The cranial nerve exam with thorough examinations of the oculomotor system
    2. Examinations of vestibular function, including the head impulse test and tests of dynamic visual acuity
    3. Tests of cerebellar function, including coordination and VOR cancellation.
  4. To perform the critical elements of the physical therapist examination of postural control and postural vertical.
  5. To recognize the clinical significance of central findings related to the physical therapist examination.
  6. To compare and contrast mechanisms of central vestibular dysfunction, including vascular, trauma, degenerative changes and space occupying lesions.
  7. To compare and contrast the prognosis and management of clients with central vestibular dysfunction