Candidate Handbook

Vestibular Rehabilitation Exam

VR Examination Policy
VR Examination Construction/Development
VR Application and Fees
VR Board Examination Review
DACNB: Complaints/Appeals of Examination

VRS:  Examination Policy:  Purpose & Eligibility

The purpose of the Vestibular Rehabilitation Specialist certification program of the American Chiropractic Neurology Board is to conduct certification activities in a manner that upholds standards for competent practice in the health care specialty of Vestibular Rehabilitation as a subspecialty of Chiropractic Neurology. The Board also conducts recertification designed to enhance the continued competence of the individual. The population of certificants are Doctors of Chiropractic who have completed specialist level training in Vestibular Rehabilitation from a chiropractic college, university, institution, foundation or agency whose program is approved by the continuing education committee of the Commission for the Accreditation of Graduate Education in Neurology (CAGEN) of a minimum of one hundred fifty (150) credit hours in Vestibular Rehabilitation and who have demonstrated competency in both written and practical examinations administered by the Board in the specialty of Vestibular Rehabilitation. The Board administers examinations for the purpose of evaluating the candidate's proficiency in Neurology and neurological subspecialties, including Vestibular Rehabilitation. Candidates who are successful in all parts of the Board Examination of the ACNB shall receive a diploma certifying that they are a

Eligibility:

1. The applicant must hold the degree of Doctor of Chiropractic from a CCE accredited college (USA) or its equivalent.
2. The applicant must show evidence of having successfully completed a post doctoral program in vestibular rehabilitation of one hundred fifty (150) credit hours from a chiropractic college, university, institution, foundation or agency whose program is approved by the continuing education committee of the Commission for the Accreditation of Graduate Education in Neurology (CAGEN). The Chiropractic College, organization, institution, foundation, or agency from which the applicant has completed his/her course of study must certify to the Board that the applicant has satisfactorily completed one hundred fifty (150) credit hours of postdoctoral instruction in Vestibular Rehabilitation.
3. The applicant must possess a license or registration to practice chiropractic and be in good standing with the respective licensing/registration agency.
4. The candidate must submit an application on a form specified by the Board within the Board designated deadline.

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Examination Construction:

All examination materials are copyrighted material of the ABCN. No reproduction or duplication of the material is permitted, unless authorized by ABCN. All draft materials utilized by examination development committee members are kept secured in a double locked enclosed area and inventoried regularly. All committee members sign confidentiality agreements when generating and/or reviewing examination materials. Any material considered unusable is shredded prior to disposal.

All duplication of examination materials has been done in a closed environment under secure arrangements. All test documents utilized by exam candidates have unique control numbers. Any examination materials delivered to an examination site by courier service have an inventory list that is signed off prior to delivery and upon opening. Once used and repackaged for courier shipment, the inventory list is completed and initialed again.

All candidates are examined utilizing the same form of the comprehensive written examination. No equivalent forms of the competency evaluation are needed. The ACNB has established a policy that all examinations will be generated in English. Written translations of the competency evaluation are not available. No adaptations of the evaluation material are utilized at this time. Accommodations for candidates with disabilities are dealt with on an individual basis in accordance with the Americans with Disabilities Act and upon special request and validation of the disability.  In accordance with American Psychological Association Standards for Test Administration, additional time may be provided to candidates who train in a language other than English, specifically in the practical/oral examination.  Again, this must be requested in advance.

Test items utilized in the examination have been keyed to an examination blueprint and validated by the collective judgment of the subject matter experts utilized via committee.  This committee performed the tasks of objective writing, case study writing, item and distractor writing.  They validate items utilizing source documents from the chiropractic neurology and vestibular rehabilitation subspecialty. All of these activities have been conducted under the direction of a consultant psychometrician subject to standards acceptable to the National Organization of Certification Agencies/National Commission for Competency Assurance (NOCA/NCCA) (USA) in as far as possible given the newness of the field.

A final review panel has been utilized to review the work of the committees and to monitor the validation procedures utilized by the committees, the linkages of the test items to the examination blueprint, and associated content specifications. The procedures utilized by the panel minimized content error on the part of the committees and have provided assurances that the committees followed generally accepted principles in item development. Each examination question has undergone this process and the items were entered into an item-banking computerized program, (LXR test software package, PAR score/PAR test) which allows the board to maintain all of the specifications of the test item relating to its linkage to the examination blueprint, job analysis, and content validity.

After a sufficient pool of questions was developed and banked into the software, an assessment was made of the number of test items developed for each content domain to ensure that there was a sufficient pool of items in each major/minor content area. Once satisfied that a sufficient pool of items existed, a form of the examination was generated according to the content specifications. Because this field is so recent, a pilot test was not possible given the very small number of individuals certified in Vestibular Rehabilitation and the number of these people involved in the writing of this examination.  This test was first administered in September of 2007 with the test takers writing comments on the test and the committees reviewing these comments along with the psychometrician evaluating the overall statistics and item analysis.  This resulted in the final test that will be administered in 2008.

A cut-score committee was assembled to establish the passing point of the examinations. The committee members selected were screened for their qualifications in the field of chiropractic neurology and Vestibular Rehabilitation. The cut-score procedure utilized was a modified Angoff procedure for determining the various passing points on both written and practical examinations. Each member of the committee rated each question that will be used in the grading of the examinations and a running mean score was calculated. When completed, the cut score for each of the examinations was determined, including the variance, standard deviation, KR 20 value, and the standard error of measurement. Each member of the multiple-choice exam Angoff cut-score committee was responsible for determining the passing point as it related to the minimally competent candidate. Prior to their initial rating, committee members were trained on cut-score methodology and provided a worksheet outlining the process with space on the worksheet to be used in describing the minimally competent candidate.

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Examination Policy:  Fees and Application

Fees:

The examination fee is set annually by the board and is non-refundable.

Application:

Applications for the Board Certification Examination are included at the end of this handbook. Candidates may also obtain applications from the Board Web site at http://www.acnb.org/application.html or from the ACNB at:

American Chiropractic Neurology Board, Inc.
8510 Hillcroft
Houston, Texas  77096

Or by telephone: (713) 772-4607 or FAX (713) 772-6015

Or via email:  Secretary@acnb.org

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Vestibular Rehabilitation and Diagnosis Board Review
Information to study and learn for the board examination

Anatomy: 
There will be questions as it pertains to the anatomy, function and possible related pathologies of these areas. 

• Anatomy of the inner, middle and outer ear
• Anatomy and understanding of the cochlea
• Anatomy and understanding of the vestibule
• Anatomy and understanding of the semi circular canals
• Anatomy and understanding of the otolithic organs
• Anatomy and understanding of the vestibulocochlear nerve
• Anatomy and understanding of the brainstem (All levels)
• Anatomy and understanding of the cerebellum and related disorders
• Anatomy and understanding of basic cortical function and Brodmann’s areas
• Anatomy and understanding of all the vasculature of the head and neck

Vestibular related physiology:

• Physiological understanding of the cupula / canals and otoliths
• Physiological understanding of endolymph and perilymph
• Physiological understanding of action potentials and vestibular nerve function
• Neuron theory, central integrated state and basic concepts of neuronal plasticity and gene responses
• Vestibular adaptation and habituation

Conditions:
Know how to differentially diagnose through all of these conditions.

• BPPV (Horizontal and posterior canal varieties)
• Cupulo- and canalithiasis
• Labyrinthitis (All related conditions)
• Perilymphatic fistula
• Meniere’s (Hydrops)
• Otosclerosis
• Vestibular neuronitis
• Acoustic neuromas
• Medullary related disorders
• Pontine related disorders
• Mesencephalic related disorders
• Cerebellar related disorders
• Multiple sclerosis
• Arnold Chiari Malformations
• Cerebellar systems and ataxia
• Autoimmune vestibulopathy
• Cervicogenic dizziness
• Bilateral vestibular loss
• Basilar migraine
• Basal ganglionic lesions
• Vestibular migraine
• Anxiety and psychogenic related dizziness
• All stokes of the brainstem (medulla / pons / mesencephalon)
• Strokes of the cerebellum
• Common tumors of the brainstem and cerebellum
• Motion sickness
• Vestibular epilepsy
• Unilateral vestibular impairment
• Mixed peripheral and central pathologies
• Ototoxicity
• Disequilibrium
• Syncope / Drop attacks
• Ramsey Hunt Syndrome
• Congenital inner ear pathologies
• Ocular tilt reactions
• Congenital nystagmus
• Superior semicircular canal dehiscence
• All systemic conditions (Ex: Thyroid, diabetes etc)

Ocular system:

• Eye muscles and related movements
• Yoked mechanisms in regards to canals and eye muscles
• Know the cranial nerves and all related pathologies
• Know the pupils and lids and related pathologies
• Spontaneous eye movements.  This includes nystagmus and oscillations
• Vestibulo-ocular responses
• Cervico-ocular responses

• Understand the physiology of hearing
• Understand sensory neural hearing loss (SNHL) and conductive hearing loss.
• Understand tinnitus

Special testing

• Understand posture testing - this includes stability, fatigue, adaptation and balance
• Understand peripheral somatic sensory pathways and their integration
• Understand Saccadic testing
• Understand tracking (Pursuit) testing
• Understand Gaze testing
• Understand fixation and spontaneous testing
• Understand all positional testing
• Understand all provocative testing
• Understand OPK / OKN testing
• Understand VOR testing, VOR suppression testing
• Understand brainstem auditory evoked responses
• Understand all therapeutic maneuvers (Epley’s, Bar-b-que roll etc..)
• Undersand basic serological laboratory studies used routinely as it relates to vestibular conditions
• Fakuda step tests
• Dix-Hallpike testing
• Understand calorics
• Understand cerebellar related physical examination tests

• VOR enhancement exercises
• Ocular motor exercises
• BPPV related exercises and post repositioning exercises
• Exercises to improve gait
• Exercises to improve balance
• Nutritional and dietary therapy

Books and references:

1. Vestibular Rehabilitation Third Edition (Susan Herdman)
2. Vestibular Rehabilitation Therapy for the Patient with Dizziness and Balance Disorders (Girardi)
3. Neurology of Eye Movement (Leigh and Zee)
4. Clinical Neurophysiology of the Vestibular System Third Edition (Baloh / Honrubia)

Content of the written test:

1. Anatomy
2. Physiology
3. Differential diagnosis
4. Reading graphs and vestibular related studies
5. Case studies
6. Information on therapy and application

Practical Examination:

1. Perform related vestibular tests
   1. Answer questions related to that test.  An example would be perform a Hallpike and be able to answer questions related to that test.
2. Any portion of any part of the neurological examination can be asked of you to perform during the test. 
   1. Your techniques will be graded and you will be asked questions related to the test.  An example would be to examine the abducens nerve.  Be able to answer questions related to any condition with that nerve.
3. Watch a video and determine the pathology present.
   1. Answer questions related to that visualized pathology.  An example would be observing and dysconjugate eye movement and being able to answer questions related to that observed pathology.   
4. Observe graphs and recordings and determine pathology.
   1. Answer questions related to those recordings.  An example would be observing a graph of nystagmus and being able to answer questions about that graph. 

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DACNB:  Complaints/Appeals of Examination

1. The Board must receive Complaints/Appeals within three (3) months of the mailing date of exam results to be considered.
2. The cost of reviewing failed parts of the examination will be non-refundable and set annually by the Board.

Disposition of Complaints: 
If a complaint or dispute arises questioning a Board action the following actions are to take place.

1. Administrative adjudication of a complaint/dispute.
2. The complainant shall specifically state the complaint in writing and submit this document to the Board Secretary for response by the Board.
3. The Board shall respond within thirty (30) days to the submitted complaint.
4. The complainant shall then have thirty (30) days to respond to the report of the Board and submit additional information supportive of his complaint.
5. The Board shall then have thirty (30) days to respond to the complaint and additional information being submitted.
6. The complainant shall then have thirty (30) days to request an Appeal for a Full Review Board.

Appeal to a full Review Board

1. Formation. If the administrative adjudication is unsuccessful and the complainant requests it in writing, then a Review Board shall be formed consisting of a Board Certified Vestibular Rehabilitation Specialist in good standing who is not a member of the Board; an individual who is either an attorney or trained in law, such as an arbitrator or hearing officer, designated by the Board, an individual designated by the complainant.
2. Procedure. The Chair of the Review Board shall be the person designated by the Board. The Review Board shall remain neutral and shall act as a judicial tribunal to hear the dispute. The Review Board shall set a date for a hearing and conduct a hearing at which time the Board shall make a presentation concerning the dispute and the complainant or representative thereof shall make a presentation concerning the dispute. Witnesses, testimony and other evidence shall be presented to the Review Board for its consideration. The Review Board shall make a finding of facts and conclusions binding all parties, within sixty (60) days of the hearing.
3. Costs. All costs for the Review Board proceedings shall be borne and paid by the non-prevailing party, including but not limited to attorney's fees and per diem expenses and remuneration of Review Board members and witnesses. In order to initiate the proceedings, the complaining party shall post with the Board a bond in the amount of fifteen thousand dollars ($15,000 U.S.), unless, upon showing of good cause, the Board determines a lesser amount appropriate. If the complaining party does not prevail, the bond amount shall be applied to the Board's costs and attorneys' fees, and any balance shall be returned. Any costs and attorneys' fees exceeding the bond amount shall be paid by, and may be recovered against, the complaining party.

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