Currently viewing Vol. 4 • Issue 4 • 2017

Striking the Right Balance – An Overview of “Vestibular Assessment and Management for Canadian Audiologists: A Scoping Review”


In this edition of “Striking the Right Balance,” Janine Verge and Michael Vekasi provide an overview of the newly released document, “Vestibular Assessment & Management for Canadian Audiologists: A Scoping Review.”

If you are a health care professional and would like to be more involved in all things vestibular, please sign-up for the Vestibular Special Interest Group. Sign-up by emailing JanineAllison.Verge@nshealth.ca to let us know you want to be included. Also, check out our Facebook page for a free list of online vestibular resources at the CAA National Vestibular Special Interest Group page.


The CAA National Vestibular Special Interest Group would like to announce the publication of the document, “Vestibular Assessment & Management for Canadian Audiologists: A Scoping Review.” This document was prepared by a joint committee of audiologists representing both the Canadian Academy of Audiology and Speech-Language & Audiology Canada.

https://canadianaudiology.ca/professional-resources/guidelines-and-position-statements/

What is a Scoping Review?

A scoping review is a type of literature review used to address a broad topic where many different study designs may be included. It is used to map key concepts especially when it is in an area that is complex and has not been reviewed comprehensively before. It is often the first step on the way to developing a systematic review. A systematic review, on the other hand, typically focuses on a well-defined question where appropriate study designs can be identified in advance and aims to provide answers to questions from a relatively narrow range of quality assessed studies.1–3

Why develop a vestibular scoping review?

Initially, the need for a scoping review document was based on survey results conducted in 2014 assessing the current state of vestibular assessment and management in Canada.4 A total of 67 Canadian audiologists who count vestibular work as part of their current practice were surveyed based on 4 vestibular themes: education, certification, standards of care, and use of supportive personnel. An overview of some key findings showed:

  1. An overwhelming majority of respondents felt that their university training was not adequate (78.6%).
  2. A total of 44% of audiologists currently working in the area of vestibular audiology received 5 or less hours of vestibular course work as a part of their formal education.
  3. Those who were unsatisfied with their university training cited lack of total hours devoted to vestibular course work and lack of hands-on training as the cause of their dissatisfaction.
  4. A lack of consistency among those that practice vestibular testing on the type of tests used.
  5. A lack of national requirements for audiologists to receive or document continuing education credits or obtain certification in vestibular testing.
  6. A total of 83% audiologists surveyed reported they would support certification in vestibular assessment and management. Comments made in support of this initiative included increased quality of testing, decreased risk of outdated procedures, disparate quality of on-the-job training, increased accountability, decreased risk of liability, increased access to training, and an elevation of our standard of care to be better recognized by other professionals.

These results demonstrated that more work needed to be done by our profession to help support audiologists performing vestibular assessment and management and to protect the public. For a complete review of survey results, please review the complete document in the following link:

http://www.canadianaudiologist.ca/issue/volume-1-issue-4-2014/department/message-from-guest-editor/

How Can this Scoping Review Be Used?

The purpose of creating this scoping review was to create a framework for audiologists who perform vestibular diagnostic assessment and management in Canada. It is important to note that the scoping review document does not represent a formal clinical practice guideline or a standard of practice and is not intended to be used as a regulatory document.

There are, however, many possible uses of it as a foundational document including to:

  1. provide a proposed outline of knowledge required for university training programs.
  2. provide information on vestibular disorders and population statistics for clinics and programs to evaluate the need for further resources.
  3. provide an outline of vestibular tests to help support audiologists in expanding their services (e.g. budget requests).
  4. provide an overview of general interpretations on common vestibular test results to provide greater consistency across Canada on test interpretation.
  5. provide clarity to government, university training programs, provincial associations and colleges, and other health care professionals such as; Physiotherapy, Occupational Therapy, Otolaryngologists, and Neurologists, of an audiologist’s role  in vestibular assessment and management.
  6. provide greater clarity on the differing job roles between an Audiologist and a hearing instrument specialist.
  7. provide information on reporting to promote consistency across clinics and programs.
  8. provide information on counselling techniques and ways to promote success of the patient.
  9. provide protection for the public to support their understanding of what kind of services are available.
  10. provide clarity about job requirements across Canada (B.C. only province with vestibular certification) for new graduates interested in the field.
  11. inform audiologists that do not specialize in vestibular assessment and management, about what questions to ask during a vestibular case history, understanding common vestibular disorders, vestibular symptoms, and the consequences of living with a vestibular disorder to better understand when to refer their patients to team members who do specialize in vestibular assessment and management.

The most important use of this document is to improve the quality of life of people living with vestibular dysfunction. Vestibular disorders, which occur in both adults and children, are linked to an increased incidence of falls, psychological and psychiatric disturbances, and cognitive impairment.5 It can be an invisible and isolating condition that can affect all aspects of life including the ability to work, relationships with family and friends, the ability to do or enjoy hobbies, drive or read. All audiologists, no matter which clinical area they specialize in, have the responsibility of helping those they serve to the fullest extent possible, including patients with vestibular dysfunction.

What is the CAA National Vestibular Special Interest Group (CNVSIG)?

The CAA national vestibular special interest group was created in 2013 with 3 strategic priorities in mind:

Strategic Priority #1: Supporting Audiologists and supportive personnel who specialize in vestibular testing and rehabilitation.
Strategic Priority #2: Enhancing communication between members of the vestibular special interest group.
Strategic Priority #3: Advocating on behalf of members.

To date, the CAA national vestibular special interest group has worked on several initiatives to meet its strategic priorities. We have a Facebook page to enhance communication and to help support members with links to free webinars, brochures, and research articles. It also provides a forum for audiologists around the world to follow Canada’s role in vestibular audiology practice.

The CNVSIG has an on-going column in the Canadian Audiologist called, “Striking the Right Balance.” This column helps support audiologists through continuing education with a focus on vestibular clinical practice in Canada. This column helps advocate to other team members on the role of an audiologist in vestibular assessment and management and helps clinicians with best practice techniques.

The publication of “Vestibular Assessment & Management for Canadian Audiologists: A Scoping Review” is another example of how the CNVSIG is working to support vestibular audiologists across Canada. If you are an audiologist who would like to get more involved in this committee and help develop and grow this exciting emerging field of audiology, please join/follow our Facebook page.

The CNVSIG would like to take this opportunity to sincerely thank the authorship committee for all of their hard work on the scoping review:

Authorship Committee

Janine Verge, AuD, Aud(C) Nova Scotia Hearing and Speech Centres, Nova Scotia (Chair)
Ronald Choquette, MOA, AuD, University of Montreal, Quebec
Carolyn Falls, MClSc, RAud, University Health Network, Ontario
Kathy Packford, MSc, RAud, Alberta Health Services, Alberta
Yvette Reid, MSc, RAUD, Providence Health Care,
Uta Stewart, AuD, Saskatoon Health Region, Saskatchewan
Michael Vekasi, MClSc, R.Aud, Aud(C), Alberta Health Services, Alberta
Erica Zaia, MSc, RAUD, Providence Health Care, British Columbia

References

  1. Arksey H and O’Malley L. Scoping studies: Towards a methodological framework. Int J Social Res Methodol: Theor Pract 2005;8(1):19–32. http://eprints.whiterose.ac.uk/1618/1/Scopingstudies.pdf
  2. Mays N, Roberts E, and Popay J. Synthesising research evidence. In N. Fulop, P. Allen, A. Clarke, & N. Black (Eds.), Studying the organisation and delivery of health services: Research methods (pp. 188-219). London: Routledge; 2001.
  3. Wilson MG, Lavis JN, and Guta A. Community-based organizations in the health sector: a scoping review. Health Research 2012;4.
  4. Verge JA and Armstrong M. Message from the guest editors. Can Audiol 2014;1(4). Available at: http://canadianaudiologist.ca/message-from-the-guest-editors/
  5. Mira E. Improving the quality of life in patients with vestibular disorders: the role of 2263 medical treatments and physical rehabilitation. Int J Clin Pract 2008;2264 Jan;62(1):109–14. doi:10.1111/j.1742-1241.2006.01091.x
About the authors

Janine Verge, AuD, Aud(C), Clinical Audiologist

Janine Verge has worked as an audiologist at the Nova Scotia Hearing and Speech Centres for the past 18 years. She obtained her BSc (Psychology) at Mount Saint Vincent University, her MSc (Audiology) from Dalhousie University, and her AuD from AT Still University. Janine won the 2009 NSHSC Advocacy Award, the 2013 NSHSC Dr. N. Barrie Coward Continuing Educational Award, and the 2017 NSHSC Outstanding Performance Award. She served as president of the Speech and Hearing Association of Nova Scotia from 2010-2013. Janine is an adjunct professor at Dalhousie University, teaching in the area of vestibular testing and management. She co-created the CAA National Vestibular Special Interest Group and is co-editor of “Striking the Right Balance,” an on-going feature column in the on-line publication Canadian Audiologist. Janine is also co-founder and committee member of the Dalhousie Hearing Aid Assistance Program. Janine is particularly interested in all things vestibular, fall prevention, and mental health advocacy.

Michael Vekasi, MClSc, RAud, Aud(C)

Michael Vekasi is a clinical audiologist with Alberta Health Services at the Glenrose Rehabilitation Hospital in Edmonton, AB. His caseload includes vestibular assessments and he is a team-member of a multi-disciplinary Vestibular Clinic. He is also a sessional instructor at MacEwan University in their hearing aid practitioner program. He obtained his Master’s of Clinical Science (Audiology) from Western University and his certificate of Advanced Studies in Vestibular Sciences and Disorders from Salus University. Michael currently serves as Vice President for the Alberta College of Speech Language Pathologists and Audiologists (ACSLPA). He was the recipient of the 2015 ACSLPA Horizon Award. Michael is co-editor of the Striking the Right Balance column in Canadian Audiologist. He is also involved with the Canadian Academy of Audiology as the Chair of the Student Committee and member of the National Vestibular Special Interest Group.. Michael is a member of the Audiology Clinical Certification Examination Committee with Speech-Language & Audiology Canada.