UTD Doctor of Audiology Program - Course Syllabus

COURSE INFORMATION
Course Number/Section AUD 7351
Course Title Physiological Assessment of the Vestibular System
Term Summer 2010
Days & Times May 24 – July 14, Monday and Wednesday - 8:30 a.m. to 11:30 a.m.
Location Callier Center Dallas, A229

PROFESSOR CONTACT INFORMATION

Professors Phillip L. Wilson, Au.D. – Course Instructor
Ross J. Roeser, Ph.D. – Course Instructor
Cindy MacArthur, M.S. – Lab Instructor and Lecturer

Guest Lecturers 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, Ph.D. – Guest Lecturer

Office Phone L. Wilson 214-905-3036

R. Roeser 214-905-3002
C. MacArthur 214-905-3028

Email Address pwilson@utdallas.edu

roeser@utdallas.edu
cindym@utdallas.edu

Office Location L. Wilson – Callier J220

R. Roeser – Callier J 211
C. MacArthur – Callier A236

Office Hours P. L. Wilson: After class and by appointment through secretary

R. By appointment through secretary
C. By appointment as needed

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 Page 1

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) 289-
2150, for $10].

Required Materials
Additional readings and materials will be distributed in class or will be available on electronic
reserve.

ELECTRONIC RESERVE
Electronic Reserve items for AUD 7351 will be available online. The URL for your electronic reserves
page is: http://utdallas.docutek.com/eres/coursepage.aspx?cid=829

The password for access to your electronic reserves is: save20sing

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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 1 and 2, pp 1-26.

Monday, May 24 Anatomy & Physiology of the Vestibular System – Dr. Wright

Please read text (Jacobson and Shepard) Chapters 3, 7-11, pp 27-44 and pp 133-252.
Wednesday, May 26 A. ENG/VNG – Dr. Roeser
B. ENG/VNG – Dr. Roeser
______________________________________________________________________________________

Monday, May 31 MEMORIAL DAY HOLIDAY

Wednesday, June 2 A. ENG/VNG – Dr. Roeser

B. ENG/VNG – Dr. Roeser
______________________________________________________________________________________

Monday, June 7 A. ENG/VNG – Dr. Roeser

B. ENG/VNG – Dr. Roeser

Please read text (Jacobson and Shepard) Chapters 23 and 24, pp 499-542.
Wednesday, June 9 A. ENG/VNG Case Studies – Dr. Wilson
B. Disorders of the Vestibular System – Dr. Wilson
______________________________________________________________________________________

Please read text (Jacobson and Shepard) Chapters 4 and 5, pp 45-98.

Monday, June 14 A. Case History for the Balance Disordered Patient – Dr. Wilson
B. Informal Tests of Balance Function – Dr. Wilson

Wednesday, June 16 Lab – Room A 225 – Mrs. MacArthur

______________________________________________________________________________________

Monday, June 21 Midterm Exam

You may schedule your final practical exam beginning June 23 through July 16

Please read text (Jacobson and Shepard) Chapters 6 and 26, pp 99-132 and 585-612.
Wednesday, June 23 A. Assessing Dizziness Related Quality of Life – Mrs. MacArthur
B. Fall Risk Assessment – Mrs. MacArthur
______________________________________________________________________________________

Case History assignment due no later than June 28

Please read text (Jacobson and Shepard) Chapter 18, pp 405-434

Monday, June 28 Vestibular Evoked Myogenic Potentials – Dr. Wilson

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Please read text (Jacobson and Shepard) Chapters 12, 13, 15, and 16, 253-318 and pp 339-378.
Wednesday, June 30 * A. Whole Body Rotational Testing – Dr. Even
B. Computerized Dynamic Posturography – Dr. Even (See note below)
______________________________________________________________________________________

Monday, July 5 Assessment and diagnostic case studies – Dr. Wilson

Disorders Paper assignment due no later than July 7

Please read text (Herdman and Tusa), entire booklet.

Wednesday, July 7 Canalith repositioning maneuvers – lab – Dr. Wilson
______________________________________________________________________________________

Please read text (Jacobson and Shepard) Chapters 21, 22 and 25, pp 469-498 and 543-584.
Monday, July 12** A. Medical and surgical treatment of vestibular disorders – Dr. Kutz
B. Vestibular Rehabilitation – Dr. Blau

Lab assignment is due on July 14

Wednesday, July 14 A. Pediatric Vestibular Issues – Dr. Simpkins

B. Review and Questions – Dr. Wilson

Take-home final exam – Due Friday, July 16, 12:00 noon.

______________________________________________________________________________________

*Note on June 30th, 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.)

** Note on July 12, Dr. Kutz will begin his lecture at 8:00 a.m., because of his clinic schedule at UT
Southwestern.

GRADING POLICY
Letter grades will be assigned based upon the following final percentages.

915-1000 points (92-100%) A

825-914 points (83-91%) B
735-824 points (74-82%) C
<735 points (<74%) F

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

1. Two written examinations (a midterm and a final), each worth 350 points.
2. Case History Assignment (150 points), described below.
3. Disorders Papers (50 points each, total = 150 points) described below.
4. Each student will demonstrate proficiency in performing vestibular assessments using ENG and VNG

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 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.
5. 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 23 and July 16. The practical exam will
take 30 minutes.

1. 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 14, 2010.

2. 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.
How long do your Attacks that last only a few seconds to a few minutes may be BPPV,
attacks of vertigo PLF, SSCD…etc…Attacks that last a few minutes to a few hours may
last? be…etc.

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

28, 2010.

3. 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

Course Syllabus Page 5

for formatting. These papers will be due in electronic form to me by email (pwilson@utdallas.edu) on
or before July 7, 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.
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.

Course Syllabus Page 6

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 manufacturer’s 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 manufacturer’s 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 university’s 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
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 one’s own work or material that is not one’s
own. As a general rule, scholastic dishonesty involves one of the following acts: cheating, plagiarism,

Course Syllabus Page 7

 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 university’s 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 student’s 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
university’s 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 respondent’s 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 Dean’s 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.

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
semester’s 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

Course Syllabus Page 8

 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 student’s 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
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

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 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.

Course Syllabus Page 10

 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 Meets Exceptional

(1-2) Expectations (5)
(3-4)
Set-up Errors in set-up affect Set-up errors exist but No set-up errors
test results are minor and do not
affect test results

Professional Fails to assume Appropriately Dripping

proper professional professional professionalism
Demeanor role during
evaluation.
Instructions Instruction errors Instruction errors are No instruction errors
affect test results minor and do not affect
test results

Performance of Procedure performed Minor procedural errors Procedure performed

incorrectly, causing do not affect test results correctly
Procedure invalid test results

Interpretation of Significant incorrect Explanation of Explanation of

explanations of expected and abnormal expected and abnormal
findings expected and findings is essentially findings is completely
abnormal findings correct with minor accurate
errors

Student Name______________________________ Date___________________

Test Performed_____________________________ Sum of Scores___________

Average Score for Test_______________________

Course Syllabus Page 11

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)

Course Syllabus Page 12