Type in keyword below and hit enter
Search Become a member
Home Log book for Balance assessment

Log book for Balance assessment

Logbook | Balance assessment

Candidate details

Contact Address
Contact Address
City
County
Post code

Supervisor details

Record of training

Clinical sessions

All of these sessions must be supervised by an appropriate staff member who meets all the requirements as required in the HTS regulations, and should be recorded in the table below. Additional sessions which do not meet the supervision requirements as outlined in the regulations cannot be counted towards the total number of minimum sessions for this module, and should not be include in this table.

Please note, these are sessions of approximately 3.5 hours, not individual patients.

Clinical sessions

Date

Supervisor
Supervision level
Direct / Indirect
Direct / Indirect
Direct / Indirect
Direct / Indirect
Direct / Indirect

Time spent on session

plus 3 Add row minus3 Delete row

Summary of HEI M level credits completed relevant to this module

Completion certificates award should be submitted with this portfolio insert when requesting examination.

Summary of HEI M level credits

Maximum file size: 73.4MB

plus 3 Add row minus3 Delete row

Tutorial Subjects

plus 3 Add row minus3 Delete row

Case Studies

Maximum file size: 73.4MB

Secondments

duration (in days) of the secondment

Maximum file size: 73.4MB

Maximum file size: 73.4MB

Clear
Signature only required if report not uploaded and signed already
plus 3 Add minus3 Remove

Placements

plus 3 Add row minus3 Delete row

Part A: Direct observation of clinical skills

Section

1. Preparation for appointment to include preparation of clinical facilities & equipment, to include positioning of the couch, flow rates and temperature of caloric stimuli and individual patient calibration with a VNG system.

Section

(Staff name /date)
(Staff name/date)

Section

2. Independently and succinctly obtains a relevant case history about the patients’ symptoms in a logical but flexible progression, and
a. Identifies possible aetiological or contributing factors as they arise and spontaneously probes for more relevant information
b. Shows sensitivity to the patients’ concerns both in questioning and information giving
c. Records relevant information whilst maintaining a rapport with the patient and being aware of their concerns
i. Referral information
ii. Medical history including medication
iii. Symptom duration, onset and chronology including precipitating/associated factors and motion/visual provoked symptoms.
iv. Otological symptoms e.g. hearing, tinnitus, aural pressure
v. Neurological symptoms e.g. migraine
vi. Effect on quality of life and employment.

Section

(Staff name /date)
(Staff name/date)

Section

3. Utilises questionnaires to establish degree of symptoms and impact balance problems are having on patient e.g. Vertigo Symptom Scale, Dizziness Handicap Inventory, Nijmegen questionnaire

Section

(Staff name /date)
(Staff name/date)

Section

4. Carry out core vestibular diagnostic tests as required, being aware of all contraindications, the safety of patient and tester, and the implication of the results:
a. Clinical and bedside tests of balance function to include
i. Romberg/Sharpened Romberg/Romberg on foam/mCTSIB
ii. Head shake
iii. Head impulse test (using video Head Impulse Test if available)
b. Positional testing to include:
i. Preparation and placement camera or direct observation
ii. Dix-Hallpike Testing (including side-lying where indicated)
iii. Horizontal roll test
c. Particle repositioning to include
i. Epley/modified Epley
ii. Semont
iii. Treatment for anterior and horizontal BPPV
d. Use of videonystagmography including preparation and placement of camera to:
i. Assess spontaneous nystagmus
ii. Assess saccadic eye movements
iii. Assess smooth pursuit eye movements
iv. Carry out bi-thermal caloric testing within the scope of the BSA recommended procedure

Section

(Staff name /date)
(Staff name/date)

Section

5. Awareness of additional diagnostic vestibular tests which may not be readily available in all clinics including
a. video head impulse testing
b. vestibular-evoked myogenic potential testing (cervical or ocular)
c. rotational chair testing
d. computerised dynamic posturography

Section

(Staff name /date)
(Staff name/date)

Section

6. Information/counselling to include:
a. Explanation of balance function
b. Typical effects of balance disorders
c. Treatment options

Section

(Staff name /date)
(Staff name/date)

Section

7. Management of associated problems, to include onward referral/sign-posting where appropriate e.g. anxiety and depression, physiotherapy, falls clinic (if available), ENT (persistent BPPV that does not treat for example).

Section

(Staff name /date)
(Staff name/date)

Section

8. Debrief to patient with regard to unilateral or bilateral vestibular weakness, central findings, BPPV and normal results with a positive vestibular history, to include:
a. Explaining results, implications and proposed management using appropriate language
b. Responding to questions from the patient in an appropriate way, showing sensitivity and rephrasing /re-explaining as necessary to ensure understanding
c. Backing up information given with information materials where possible 

Section

(Staff name /date)
(Staff name/date)

Section

9. Keep appropriate clinical records: record findings and interventions delivered clearly, in a consistent format, all of which must be dated and named.

Section

(Staff name /date)
(Staff name/date)

Section

10. Write reports on assessment sessions, recommended treatment plans and / or outcome of treatment as required, suitable for the intended audience, to include a range of professionals.

Section

(Staff name /date)
(Staff name/date)

Part B - Periodic Appraisals of Competencies

New adult balance assessment appointment

Internal Assessor/External Assessor in Home Department/External Assessor On Secondment

Please leave blank if not applicable

Competency 1:
Prepare test facilities & equipment, to include daily calibration checks and room set up.
Competency 2:
Brief patients and/or carers appropriately with reference to their information needs and expectations of assessment.
Competency 3:
Take a full and relevant history which informs an individualised test strategy.
Competency 4:
Formulate and plan clinical approaches, using clinical reasoning strategies, with reference to identified purpose of assessment and information needs of others.
Competency 5:
Show creativity, initiative and originality of thinking in tackling and solving practical problems
Competency 6:
Carry out testing in a safe and effective manner adapting as required to ensure information gained is maximised within the time available.
Competency 7:

Collate relevant information, interpret and make an informed decision concerning the diagnosis and management of individual cases.
Competency 8:
Give clear information on results of balance assessment, advice and recommendation for follow-up actions/interventions using appropriate language and communication strategies.
Competency 9:
Recognise the need for and arrange onward referral to relevant professionals such as referral to physiotherapy, a local falls clinic or to mental health services for support with anxiety/depression.
Competency 10:
Write reports on test results and recommendations and / or outcome of treatment as required, suitable for the intended audience, to include a range of professionals
Competency 11:
Keep appropriate clinical records  
Competency 12:

Demonstrate the ability to, and articulate clearly through presentation and constructive discussion with colleagues:
a. Relate their own practice to a supporting knowledge base – including reference to evidence based and/or recognised good practice
b. Clearly justify any of their own clinical decisions made in the assessment or management of patients
c. Critically appraise the context of individual assessments within national and local structures/processes for assessment and diagnosis of balance disorders
d. Critically evaluate and reflect on their own actions
e. Show independent thought through evaluation and presentation of alternative (and justified) approaches to existing local practice

0: Does not currently meet examination requirements
1: Meets examination requirements
2: Exceeds examination requirements

Agreed to reassess inweeks
plus 3 Add table minus3 Delete

Supervisor’s Final Report and Sign-off

I confirm that this candidates training has been completed as per the module specification. I would like an exam to be arranged.

Maximum file size: 73.4MB

Please tick if resit is required

Resit information

Area below only for use when applying to resit the practical examination.

I confirm that I am satisfied the candidate is now ready to resit exam

Save / submit

If you have completed this module and are ready to submit this logbook check the box below, otherwise you can save your progress and come back to this later.

Assessors