"dizzy!?" is written from the perspective of Physical Therapist, Andy Beltz, who has worked primarily with people who have dizziness and balance disorders since the year 2000. This blog should not be used as a tool to diagnose or treat a health problem you may be having. You should see your Medical Doctor to be diagnosed or go to the Emergency Department if you are not sure why you are dizzy.

Thursday, August 27, 2015

Education, Experience and Honors of Andy Beltz, PT

Andy Beltz, PT:   Education, Experience, and Honors


Graduated from Bowling Green State University in consortium with The Medical College of Ohio with bachelor’s degree in physical therapy
Vestibular Rehabilitation mentorship from Dr. Mark Vogelgesang, ENT and the late Dr. Richard Dickerhoof, Au.D.
Basic and advanced Vestibular Rehabilitation certificates of competency earned from Emory University in Atlanta, Georgia 
2000, 2001
Attended various CE courses from world renowned experts in Vestibular Rehabilitation
1999 - present
Instructor of Tai Chi for Arthritis certification


Staff Outpatient PT at Aultman (with specialty in Vestibular Rehabilitation including regular use of video eye movement recorder.) 
     Treated an estimated 3000 cases of Benign Paroxysmal Positional Vertigo
     Treated and estimated 6000 cases relating to dizziness and imbalance in general.
     Charge therapist
Float PT (Acute, Home Care, Outpatient, etc) at Aultman
Clinical Research- Principal investigator for bedside   vestibular testing study through Aultman Research Academy
Supervisor for Internal Medicine and Family Practice Resident’s vestibular clinical rotation at Tusc Therapy (over 80 Residents to 2015)
Clinical instructor for Physical Therapy students
Coordinator for PT clinical site affiliations
Continuing education provider for Vestibular Rehab
Co-chair of Shared Governance Council
Supervisor for specialized Vestibular Rehab capstone clinical practicum
2008, 2013, 2015
Participated in radio interview, open house, community talks (non-health talk), newsletter and newspaper publications
Action Academy participant
Assisted in Spirit of Inquiry study
Speaker for Health Talks
Chair of Performance Improvement and Quality Committee-Tusc Therapy
Project Manager for IHN staffing services
Team member for Excelerator (Gallup) survey committee
Exploring Leaders participant
Leader for Outing committee
Leader for Tusc Time Outs
Lead Super User training Physicians on use of Cerner
Staff Acute PT at Aultman


Aultman Points of Caring Award
Speaker at Ohio Physical Therapy Association conference
2012, 2014
Walsh Adjunct Faculty Member
Speaker at Union Hospital’s “Leadership Is” conference
Aultman “You Make a Difference” Award
Aultman “Winning With Teamwork” Award
Successful completion of the “Clinical Career Enhancement Program”
Aultman “Patient Satisfaction” Award
Aultman “Rising Star” Award


Monday, January 5, 2015

Woodlawn 2015

Downloads to compliment vestibular course:

Vestibular Screening and Treatment in Orthopaedic Practice: When to Refer by Andy Beltz, PT

Larger slides for main powerpoint presentation
Large slides

Why we get dizzy with vestibular rehab summary
Flow chart

354 different words and phrases to describe dizzy:
What do you mean by dizzy?

Nice history algorithm:

Dizziness trigger and vicious cycle explanation for client and recommendations for therapist:
Dizziness trigger/vicious cycle help!

Tips for breaking the vicious cycle of dizziness
Helpful tips

Quick reference for Vestibular Rehab
Cheat sheet

Lateral canal rules updated
Pseudospontaneous, Gufoni, etc

Tuesday, February 11, 2014

Here is a link to an awesome app for learning

about BPPV and the vestibular system in general:


Also can be found by searching "avor" under the apps page.

Monday, November 4, 2013

If you had four hours to learn how to do vestibular rehabilitation

what would be the most important concepts on which to focus?  I believe the following would be the most important:
1.  The most common causes of dizziness are from peripheral vestibular problems.
2.  There are two main types of peripheral vestibular problems:
     a.  vestibular hypofunction
     b.  vestibular hyperfunction
3.  The most common cause of a vestibular hypofunction is neuritis/labyrinthitis (virus).
4.  The most common cause of a vestibular hyperfunction is BPPV.
5.  Understanding how these problems occur will help the individual understand the type of questions to ask their clients when they say they are dizzy.
6.  There are over 320 different ways people describe their dizziness, but there are some very specific questions to ask to help identify neuritis, labyrinthitis and/or BPPV.
7.  There are some simple bedside tests that can be used to identify a hypofunction in room light:
    a. spontaneous and gazehold nystagmus tests as well as the head impulse test
8.  The Dix Hallpike and Roll tests can be utilized to identify BPPV.
9.  Naming nystagmus can improve the likelihood for successful repositioning.
10.  The Epley and Semont Maneuvers are often helpful if done properly and to the correct side.
11.  Other maneuvers may be needed when the Otoconia are rebellious or in other canals.
12.  Repositioning should be done for BPPV and Adaptation should be done for hypofunctions.
13.  Sensory processing disorders may also be present with clients who are dizzy and are common.
14.  Motion sensitivity, visual dependence, neck pain, headaches, imbalance, fear of falls and other forms of anxiety are common.
15.  Other types of therapy and motivational education may be needed to normalize neck strength, ROM and improve nervous system homeostasis.
16.  Clients should be referred to specialists when: the dizziness is acute and/or has not been diagnosed, when the practitioner lacks adequate training, when treatment has not worked or provided any relief within three to six visits, when red flags become apparent during the history or exam.
17.  Beware of the trap of "It."
18   There are often several reasons for the complaints of dizziness a client is experiencing.

Sunday, November 3, 2013

Plowing your driveway in the middle of a blizzard is like trying to fix an inner ear

problem before the cause of the inner ear problem has stabilized.  A person who can't stand having snow on their driveway must wait until the snow stops before plowing or shoveling their driveway to yield lasting results.  Trying to fix an inner ear problem, like BPPV, before the cause of the BPPV has stabilized is similar.  You can do repositioning maneuvers all day long, but if the calcium crystals are still in the process of dumping out, the repositioning attempt will likely only provide temporary relief.  I have learned that treating acute BPPV is not the same as treating chronic BPPV.  Sometimes, an inner ear needs time after the calcium crystals have fallen out before repositioning is effective.  On the other hand, I have also noticed repositioning within hours of an individual becoming aware of their BPPV has also been effective.  Different people have different types of BPPV.

Saturday, October 5, 2013

Go and Spin No More

Oh how great it would be to miraculously heal people battling dizziness.  So many are suffering and looking for help.  For BPPV, the canalith repositioning maneuvers work so well many think they have received some type of miraculous treatment.  However, many have vertigo from problems other than BPPV.   We learn more each day and new treatment options become available with time.