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UTD Doctor of Audiology Program - Course Syllabus

COURSE INFORMATION
Course Number/Section Course Title Term Days & Times Location AUD 7351 Physiological Assessment of the Vestibular System Summer 2011 May 23 July 13, Monday and Wednesday - 8:30 a.m. to 11:30 a.m. Callier Center Dallas, A229

PROFESSOR CONTACT INFORMATION


Professors Phillip L. Wilson, Au.D. Course Instructor Ross J. Roeser, Ph.D. Course Instructor Alexa Murzyn, Au.D. Lab Assistant and Guest Lecturer Gary Wright, Ph.D. - Guest Lecturer Bill Even, Au.D. - Guest Lecturer Walter Kutz, M.D. Guest Lecturer Patti Blau, Ph.D. - Guest Lecturer Susan Simpkins, Ed.D. Guest Lecturer L. Wilson 214-905-3036 R. Roeser 214-905-3002 pwilson@utdallas.edu roeser@utdallas.edu L. Wilson Callier J220 R. Roeser Callier J 211 Wilson: After class and by appointment. Roeser: By appointment through secretary

Guest Lecturers

Office Phone

Email Address

Office Location

Office Hours

COURSE PRE-REQUISITES, CO-REQUISITES, AND/OR OTHER RESTRICTIONS


Advanced Clinical Audiology AUD 6310 Diagnostic Audiology AUD 6311. Anatomy and Physiology of Audition AUD 6305

Course Syllabus

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COURSE DESCRIPTION
Anatomy, physiology and pathophysiology of the vestibular, oculomotor and related systems used for maintaining equilibrium and balance. Assessment of history, signs and symptoms, and self-perceived handicap to develop differential diagnosis. Procedures used for diagnostic assessment of the vestibular system including informal evaluation techniques, ENG/VNG, rotary chair testing, platform posturography, and VEMP. Medical and non-medical treatments for vestibular and non-vestibular balance disorders.

STUDENT LEARNING OBJECTIVES/OUTCOMES


After completing this course, students should be able to: 1. Identify the structures of the vestibular system crucial to enabling an individual to maintain equilibrium and balance, and discuss the function of these structures in a normal system. 2. Identify the vestibular nervous system pathways, and discuss the relationship of these pathways to oculomotor and proprioceptive response to external stimuli. 3. Identify potential disorders affecting the balance system, and identify the possible physiological results of the pathology. 4. Take the history of a patient with complaints of dizziness and relate the symptoms to possible disorders of the balance system. 5. Perform a variety of informal diagnostic procedures and use the results to recommend appropriate formal evaluation or diagnostic referrals. 6. Perform an ENG/VNG. 7. Interpret the findings of an ENG/VNG 8. Perform a canalith repositioning maneuver. 9. Identify appropriate physical therapy treatment referral criteria for adults and children based upon evaluation results and history.

REQUIRED TEXTBOOKS AND MATERIALS


Required Texts 1. Jacobson, Gary P. and Shepard, Neil T. eds., Balance Function Assessment and Management. Plural Publishing: San Diego, CA, 2008. 2. Herdman, Susan J. and Tusa, Ronald J., Diagnosis and Treatment of Benign Paroxysmal Positional Vertigo. GN Otometrics: Schaumberg, IL, 2004. [Available through GN Otometrics, (800) 2892150, for $10]. Required Materials Additional readings and materials will be distributed in class or will be available on electronic reserve.

ELECTRONIC RESERVE
Certain additional readings will be available through Electronic Reserve when possible. The URL for electronic reserves page is: http://bit.ly/dM2A8S The password for access to electronic reserves is: arm87shore

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ACADEMIC CALENDAR & ASSIGNMENTS


(Class schedule subject to change as needed)

Topics with reading assignments, EXAM DATES and assignment due dates: ______________________________________________________________________________________ Please read text (Jacobson and Shepard) Chapters 3, 7-11, pp 27-44 and pp 133-252 Monday, May 23 A. B. A. B. ENG/VNG Dr. Roeser ENG/VNG Dr. Roeser ENG/VNG Dr. Roeser ENG/VNG Dr. Roeser

Wednesday, May 25

______________________________________________________________________________________ Monday, May 30 Wednesday, June 1 MEMORIAL DAY HOLIDAY

A. ENG/VNG Dr. Roeser B. ENG/VNG Dr. Roeser ______________________________________________________________________________________ Please read text (Jacobson and Shepard) Chapters 1 and 2, pp 1-26. Also read Roeser et al., Audiology Diagnosis, Chapter 4, pp 65-76. Monday, June 6 A. Disorders Affecting Balance Dr. Wilson B. Anatomy and Physiology of the Vestibular System Dr. Wright Please read text (Jacobson and Shepard), Chapter 4, pp 45-62. Wednesday, June 8 A. Vestibular Pathophysiology and Vestibular Compensation Dr. Wilson B. Case History for the Balance Disordered Patient Dr. Wilson ______________________________________________________________________________________ Please read text (Jacobson and Shepard), Chapter 5, pp 63-97. Monday, June 13 A. Informal Tests of Balance Function Dr. Wilson B. Diagnostic Case Studies - Common Vestibular Disorders - Dr. Wilson Wednesday, June 15 Lab Room A 225 Dr. Murzyn ______________________________________________________________________________________ Monday, June 20 MIDTERM EXAM

You may schedule your final practical exam beginning June 22 through July 15 Please read text (Jacobson and Shepard), Chapter 6 and 26, pp 99-131 and pp 585-612. Wednesday, June 22 A. Assessing Dizziness Related Quality of Life Dr. Murzyn B. Fall Risk Assessment Dr. Murzyn ______________________________________________________________________________________

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Case History assignment due no later than June 27 Please read text (Jacobson and Shepard), Chapter 18, pp 405-434. Monday, June 27 Vestibular Evoked Myogenic Potentials, Lecture and Lab Dr. Wilson Please read text (Jacobson and Shepard), Chapters 12 and 13, and Chapters 15 and 16; pp 253-318 and pp 339-378. Wednesday, June 29 * A. Whole Body Rotational Testing Dr. Even B. Computerized Dynamic Posturography Dr. Even (See note below) ______________________________________________________________________________________ Monday, July 4 Independence Day Holiday

Disorders Paper assignment due no later than July 6 Please read text (Herdman and Tusa), entire booklet. Wednesday, July 6 A. BPPV Treatment lecture and Canalith repositioning maneuver lab Dr. Wilson B. Non-medical treatment of common vestibular disorders Dr. Wilson ______________________________________________________________________________________ Please read text (Jacobson and Shepard), Chapter 21 and 25; pp 469-478 and pp 543-584. Monday, July 11** A. Medical and surgical treatment of vestibular disorders Dr. Kutz B. Vestibular Rehabilitation Dr. Blau Lab assignment is due on July 13 Wednesday, July 13 A. B. Pediatric Vestibular Issues Dr. Simpkins Review and Questions bringing it all together Dr. Wilson

TAKE-HOME FINAL EXAM DUE FRIDAY, JULY 15, 12:00 NOON. ______________________________________________________________________________________ *Note on June 29th, Dr. Even will present two lectures at UTSWMC in the ENT conference room. Following the lectures students will have the opportunity to visit the rotary chair and DPP labs. (Students who wish to walk as a group to the lecture site should meet at 8:30 a.m. in Room A229 at the Callier Center.)

GRADING POLICY
Letter grades will be assigned based upon the following final percentages. 915-1000 points 825-914 points 735-824 points <735 points (92-100%) (83-91%) (74-82%) (<74%) A B C F

The final grade will be based on performance on two written examinations (midterm and final), a practical examination and other assignments described below.

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1. 2. 3. 4.

5.

Two written examinations (a midterm and a final), each worth 350 points. Case History Assignment (150 points), described below. Disorders Papers (50 points each, total = 150 points) described below. Each student will demonstrate proficiency in performing vestibular assessments using ENG and VNG techniques and informal evaluation techniques to the course instructors. The practical examination will be performed by appointment between June 23 and July 16. A rubric is provided which will describe the essential components required (see attached). This practical examination will be graded as satisfactory or unsatisfactory. An unsatisfactory practical examination will lower the final course grade by 30 points. Perform one ENG/VNG assessment and submit data and reports to Dr. Wilson on or before July 14, 2009. This report will be graded as satisfactory or unsatisfactory. Unsatisfactory assessment and/or report will lower the final course grade by 30 points.

ASSIGNMENTS
1. Final Practical Examination Be prepared to perform any portion of the ENG/VNG battery and any of the informal or bedside tests described during classroom lectures. Perform the tests requested as if you were an audiologist and your subject were a patient in a balance clinic. Your performance on the practical examination will be graded satisfactory/unsatisfactory based upon the attached rubric. Please schedule your final practical examination by appointment with Dr. Wilson between June 22 and July 15. The practical exam will take 30 minutes. 2. Lab Assignment: ENG/VNG Assessment Perform a complete ENG or VNG on an adult classmate, family member or other volunteer of your choosing using equipment available in the UTD/Callier Center Clinical Division. Perform all tests that are described in classroom lectures that are considered to be part of a standard ENG/VNG assessment. Print out all results and write a complete professional report describing the results. This assignment is due to Dr. Wilson by July 13, 2010. 3. Case History Assignment The attached case history form contains many items about which a patient with a balance disorder is asked to give information. Create a spreadsheet, listing each item on the form and indicate the reason that the information is important. For example: Question Significance This information is important because the length of the attack points toward specific disorders that the practitioner must consider. Attacks that last only a few seconds to a few minutes may be BPPV, PLF, SSCDetcAttacks that last a few minutes to a few hours may beetc.

How long do your attacks of vertigo last?

This spreadsheet is due in electronic form to me by email (pwilson@utdallas.edu) on or before June 27, 2010.

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4. Disorders Papers Assignment Write three short (Maximum 1 page, single-spaced per disorder) bulleted information sheets on the attached assigned disorders using the attached format. Please pay close attention to font style, size and instructions for formatting. These papers will be due in electronic form to me by email (pwilson@utdallas.edu) on or before July 6, 2010.

COURSE POLICIES
Make-up exam No make-up examinations will be given except for good cause and unless approved by the course instructor. Students approved for make-up examinations will be given an alternate date upon request. Extra Credit No provision is made for extra credit. Late Work All assignments must be turned in on time. Late assignments may result in reducing the grade for the class. Special Assignments There are no special assignments. Class Attendance Students are not required to attend class. However, most students find that they are unable to pass examinations without regular attendance. Classroom Citizenship Students should be respectful of other students, the professors and guest lecturers. Field Trip Policies / Off-Campus Instruction and Course Activities One off-campus lecture is planned. It is highly recommended that all students attend this lecture.

ASHA COMPETENCIES COVERED BY THE COURSE


Standard IV-B Foundations of Practice B 4. Anatomy and physiology, pathophysiology and embryology and development of the auditory and vestibular systems. B 11. Instrumentation and bioelectrical hazards B.12. Infectious/contagious diseases and universal precautions. B 14. Physical characteristics and measurement of electric and other nonacousatic stimuli. B 16. Medical/surgical procedures for treatment of disorders affecting auditory and vestibular systems. Standard IV-C Prevention and Identification C 1. Interact effectively with patients, families, other appropriate individuals and professionals. Standard IV-D Evaluation D 1. Interact effectively with patients, families, other appropriate individuals and professionals. D 3. Obtain a case history.

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D 4. Perform an otoscopic examination. D 5. Determine the need for cerumen removal. D 6. Administer clinically appropriate and culturally sensitive assessment measures. D 7. Perform audiologic assessment using physiologic, psychophysical and self-assessment measures. D 8. Perform electrodiagnostic test procedures. D 11. Document evaluation procedures and results. D12. Interpret results of the evaluation to establish type and severity of disorder. D 13. Generate recommendations and referrals resulting from the evaluation process. D 14. Provide counseling to facilitate understanding of the auditory and balance disorder. D 16. communicate results and recommendations orally and in writing to the patient and other appropriate individual(s). D 17. Use instrumentation according to manufacturers specifications and recommendations. D 18. Determine whether instrumentation is in calibration according to accepted standards. Standard IV-E Treatment D 1. Interact effectively with patients, families, other appropriate individuals and professionals. E 2. Develop and implement treatment plan using appropriate data. E 4. Counsel patients, families and other appropriate individuals. E 6. Collaborate with other service providers in case coordination. E 15. Document treatment procedures and results. E 16. Maintain records in a manner consistent with legal and professional standards. E 17. Communicate results, recommendations and progress to appropriate individual(s). D 18. Use instrumentation according to manufacturers specifications and recommendations. D 19. Determine whether instrumentation is in calibration according to accepted standards.
Student Conduct & Discipline
The University of Texas System and The University of Texas at Dallas have rules and regulations for the orderly and efficient conduct of their business. It is the responsibility of each student and each student organization to be knowledgeable about the rules and regulations which govern student conduct and activities. General information on student conduct and discipline is contained in the UTD publication, A to Z Guide, which is provided to all registered students each academic year. The University of Texas at Dallas administers student discipline within the procedures of recognized and established due process. Procedures are defined and described in the Rules and Regulations, Board of Regents, The University of Texas System, Part 1, Chapter VI, Section 3, and in Title V, Rules on Student Services and Activities of the universitys Handbook of Operating Procedures. Copies of these rules and regulations are available to students in the Office of the Dean of Students, where staff members are available to assist students in interpreting the rules and regulations (SU 1.602, 972/883-6391). A student at the university neither loses the rights nor escapes the responsibilities of citizenship. He or she is expected to obey federal, state, and local laws as well as the Regents Rules, university regulations, and administrative rules. Students are subject to discipline for violating the standards of conduct whether such conduct takes place on or off campus, or whether civil or criminal penalties are also imposed for such conduct.

ACADEMIC INTEGRITY

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The faculty expects from its students a high level of responsibility and academic honesty. Because the value of an academic degree depends upon the absolute integrity of the work done by the student for that degree, it is imperative that a student demonstrate a high standard of individual honor in his or her scholastic work. Scholastic dishonesty includes, but is not limited to, statements, acts or omissions related to applications for enrollment or the award of a degree, and/or the submission as ones own work or material that is not ones own. As a general rule, scholastic dishonesty involves one of the following acts: cheating, plagiarism, collusion and/or falsifying academic records. Students suspected of academic dishonesty are subject to disciplinary proceedings. Plagiarism, especially from the web, from portions of papers for other classes, and from any other source is unacceptable and will be dealt with under the universitys policy on plagiarism (see general catalog for details). This course will use the resources of turnitin.com, which searches the web for possible plagiarism and is over 90% effective.

EMAIL USE
The University of Texas at Dallas recognizes the value and efficiency of communication between faculty/staff and students through electronic mail. At the same time, email raises some issues concerning security and the identity of each individual in an email exchange. The university encourages all official student email correspondence be sent only to a students U.T. Dallas email address and that faculty and staff consider email from students official only if it originates from a UTD student account. This allows the university to maintain a high degree of confidence in the identity of all individual corresponding and the security of the transmitted information. UTD furnishes each student with a free email account that is to be used in all communication with university personnel. The Department of Information Resources at U.T. Dallas provides a method for students to have their U.T. Dallas mail forwarded to other accounts.

WITHDRAWAL FROM CLASS


The administration of this institution has set deadlines for withdrawal of any college-level courses. These dates and times are published in that semester's course catalog. Administration procedures must be followed. It is the student's responsibility to handle withdrawal requirements from any class. In other words, I cannot drop or withdraw any student. You must do the proper paperwork to ensure that you will not receive a final grade of "F" in a course if you choose not to attend the class once you are enrolled.

STUDENT GRIEVANCE PROCEDURES


Procedures for student grievances are found in Title V, Rules on Student Services and Activities, of the universitys Handbook of Operating Procedures. In attempting to resolve any student grievance regarding grades, evaluations, or other fulfillments of academic responsibility, it is the obligation of the student first to make a serious effort to resolve the matter with the instructor, supervisor, administrator, or committee with whom the grievance originates (hereafter called the respondent). Individual faculty members retain primary responsibility for assigning grades and evaluations. If the matter cannot be resolved at that level, the grievance must be submitted in writing to the respondent with a copy of the respondents School Dean. If the matter is not resolved by the written response provided by the respondent, the student may submit a written appeal to the School Dean. If the grievance is not resolved by the School Deans decision, the student may make a written appeal to the Dean of Graduate or Undergraduate Education, and the deal will appoint and convene an Academic Appeals Panel. The decision of the Academic Appeals Panel is final. The results of the academic appeals process will be distributed to all involved parties.

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Copies of these rules and regulations are available to students in the Office of the Dean of Students, where staff members are available to assist students in interpreting the rules and regulations.

INCOMPLETE GRADE POLICY


As per university policy, incomplete grades will be granted only for work unavoidably missed at the semesters end and only if 70% of the course work has been completed. An incomplete grade must be resolved within eight (8) weeks from the first day of the subsequent long semester. If the required work to complete the course and to remove the incomplete grade is not submitted by the specified deadline, the incomplete grade is changed automatically to a grade of F.

DISABILITY SERVICES
The goal of Disability Services is to provide students with disabilities educational opportunities equal to those of their non-disabled peers. Disability Services is located in room 1.610 in the Student Union. Office hours are Monday and Thursday, 8:30 a.m. to 6:30 p.m.; Tuesday and Wednesday, 8:30 a.m. to 7:30 p.m.; and Friday, 8:30 a.m. to 5:30 p.m. The contact information for the Office of Disability Services is: The University of Texas at Dallas, SU 22 PO Box 830688 Richardson, Texas 75083-0688 (972) 883-2098 (voice or TTY) Essentially, the law requires that colleges and universities make those reasonable adjustments necessary to eliminate discrimination on the basis of disability. For example, it may be necessary to remove classroom prohibitions against tape recorders or animals (in the case of dog guides) for students who are blind. Occasionally an assignment requirement may be substituted (for example, a research paper versus an oral presentation for a student who is hearing impaired). Classes enrolled students with mobility impairments may have to be rescheduled in accessible facilities. The college or university may need to provide special services such as registration, note-taking, or mobility assistance. It is the students responsibility to notify his or her professors of the need for such an accommodation. Disability Services provides students with letters to present to faculty members to verify that the student has a disability and needs accommodations. Individuals requiring special accommodation should contact the professor after class or during office hours.

RELIGIOUS HOLY DAYS


The University of Texas at Dallas will excuse a student from class or other required activities for the travel to and observance of a religious holy day for a religion whose places of worship are exempt from property tax under Section 11.20, Tax Code, Texas Code Annotated. The student is encouraged to notify the instructor or activity sponsor as soon as possible regarding the absence, preferably in advance of the assignment. The student, so excused, will be allowed to take the exam or complete the assignment within a reasonable time after the absence: a period equal to the length of the absence, up to a maximum of one week. A student who notifies the instructor and completes any missed exam or assignment may not be penalized for the absence. A student who fails to complete the exam or assignment within the prescribed period may receive a failing grade for that exam or assignment. If a student or an instructor disagrees about the nature of the absence [i.e., for the purpose of observing a religious holy day] or if there is similar disagreement about whether the student has been given a reasonable time to complete any missed assignments or examinations, either the student or the instructor may request a ruling from the chief executive officer of the institution, or his or her designee. The chief executive officer or

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designee must take into account the legislative intent of TEC 51.911(b), and the student and instructor will abide by the decision of the chief executive officer or designee.

OFF-CAMPUS INSTRUCTION AND COURSE ACTIVITIES


Off-campus, out-of-state, and foreign instruction and activities are subject to state law and University policies and procedures regarding travel and risk-related activities. Information regarding these rules and regulations may be found at the website address given below. Additional information is available from the office of the school dean. (http://www.utdallas.edu/Business Affairs/Travel_Risk_Activities.htm)

THESE DESCRIPTIONS AND TIMELINES ARE SUBJECT TO CHANGE AT THE DISCRETION OF THE PROFESSOR.
Please continue, below, for attachments.

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AUD 7351 Physiologic Assessment of the Vestibular System Practical Examination Rubric

As part of your course grade, you will be asked to perform procedures or parts of procedures used in the evaluation of patients with balance complaints, and explain expected findings and the implication of abnormal findings. Your performance for each procedure will be graded in each of the five areas in the left-hand column with a score between 1 and 5. Total scores of all procedures will be averaged together. An average score <3.5 is unsatisfactory.

Objective

Score Unsatisfactory (1-2)


Errors in set-up affect test results Fails to assume proper professional role during evaluation. Instruction errors affect test results Procedure performed incorrectly, causing invalid test results Significant incorrect explanations of expected and abnormal findings

Meets Expectations (3-4)


Set-up errors exist but are minor and do not affect test results Appropriately professional

Exceptional (5)
No set-up errors

Set-up Professional Demeanor Instructions Performance of Procedure Interpretation of findings

Dripping professionalism

Instruction errors are minor and do not affect test results Minor procedural errors do not affect test results Explanation of expected and abnormal findings is essentially correct with minor errors

No instruction errors

Procedure performed correctly Explanation of expected and abnormal findings is completely accurate

Student Name______________________________ Test Performed_____________________________ Average Score for Test_______________________

Date___________________ Sum of Scores___________

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Disorders Papers should follow this format Use Times New Roman Font, Size 12 DISORDER NAME (BOLD, ALL CAPS) AUTHOR OF PAPER (BOLD, ALL CAPS) Nature of the disorder/phenomenon (Not bold, but underlined) (Bullets, complete sentences not necessary)

Nature of its effect on balance function

Key factors in its diagnosis

Management of balance symptoms caused by the disorder References minimum 3 (APA style bibliography)

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