Speaker You’re listening to Allied Health Podcast, talking all things Allied Health with your hosts, Danielle Weedon, physiotherapist and Clare Jones, occupational therapist.

Danielle Weedon Today we’re talking to Gretta Palmer. Greta is a vestibular physiotherapist working at Princess Alexandra Hospital in Brisbane.

Clare Jones Hi Gretta, and welcome to Allied Health Podcast.

Gretta Palmer Hi Clare, Hi Danielle. Thanks for having me.

Clare Jones Now as Dan has mentioned, you’re an experienced physio who is specialised in the very niche area of vestibular physiotherapy. We’re really keen to hear how you came to specialise in such a niche area and we’re also keen to hear about your career pathway as a physio in general. I know when I started my occupational therapy degree, I never imagined that I’d forge a career in allied health recruitment and career coaching. And Dan, I know this goes for you as well. So we always find it interesting to hear how people have ended up where they are today in their career.

Danielle Weedon The first question, Gretta, and it’s an obvious one, but did you always aspire to be a vestibular physio?

Gretta Palmer No, not at all. When I went to uni over 25 years ago, we didn’t even learn about vestibular. Now I was a fairly diligent student – I went to all my lectures and pracs and I can honestly not even remember the word being mentioned. So I have only become a vestibular physiotherapist fairly late in my career and it’s really only captured my interest in about the last ten years or so.

Clare Jones That’s interesting. So, do you want to just run us through your career to date, Gretta?

Gretta Palmer Yes. So I’ve got a fair bit of ground to cover, so I’ll try and give you a quick rundown. But overall, my career hasn’t exactly been linear in its progression. There’s been lots of ups and downs. So I graduated in 1996 from the University of Queensland and I accepted a job as a new graduate physio at Royal Brisbane and Women’s Hospital. And like all new grad physios, I was in the rotational pool during my time in all the different areas and I loved them all. Lots of on call work, lots of weekends, saved up enough money to go overseas. And I would like to say it was for the work experience, but it was to travel and see the world, so that’s what I did. And I came back and pretty much did a similar kind of thing for the next few years, still with no real clear focus. And then I got married and we went overseas a second time. So both of these stints overseas, although I really enjoyed them, they weren’t with a specific career focus in mind – it was about the travel. But when I came back, I definitely started to find an interest in rehabilitation and geriatric and neurology. And so I worked for a few years and worked my way up into a senior physiotherapy role at that point. So I was about eight years post uni, I was tracking quite well. I’d done two stints overseas. I’d worked my way up into this senior physiotherapy role and then I had time off to have my children. So I had three kids in four years and so that didn’t leave a lot of time for work as you can imagine. So I had time off and I really enjoyed that time off. I don’t regret it at all.

Clare Jones Let’s just clarify that Gretta – it’s not really time off, is it? It’s more time on having three kids in four years is more time on, than time off.

Gretta Palmer And I got to pursue other things as well. So other non physio things. So it was a really good career break. But when I came back after having this break, I completely underestimated how hard it would be to start again. And I also changed hospitals at that point. So that was when I changed to the Princess Alexandra Hospital. And I did that for a couple of reasons, primarily for work life balance, because I could walk to the hospital and with three young kids, that just made sense. Also, the PA has a strong rehab focus. So we have a number of different specialty rehab wards and it just seemed like it would be a really good fit for me. So I made the change, so I relinquished my senior physiotherapy job and started again at the bottom. And it was hard because no one knew me, no one knew the things that I’d done, no one knew anything about me. And I guess I was lacking some confidence because I’ve been out of the career, out of the workforce for a while, and I found it really hard. My morale was down and I talk about it as being my career ditch. So I knew I had to find a way to get out. I had no job security because I was trying to get a permanent job and it was very competitive at that time. And so the first the first thing was to get a permanent job, which I did. But I had little job satisfaction at that point because I was rotating through all the different areas of the hospital. So, you know, one rotation, I’d be in the geriatric ward and the next rotation I’d be in the general medicine ward and then the next rotation I might be in orthopaedics. So I was back in the rotational pool doing all these different areas. But what happened as I was working across all the different parts of the hospital, I would see these dizzy patients pop up across the whole hospital spectrum. And I also saw that no one was confident treating them, no one knew how to treat them. As physios, we weren’t treating them. And even the doctors didn’t seem to have a good understanding of dizziness and vertigo. So I saw this need and this was probably about ten years ago when I saw a need to manage the dizzy patients in my hospital better. And so I made this conscious decision to upskill myself, and no one asked me to do it but I just put in a lot of work behind the scenes, lots of reading going on, lots of courses and started treating dizzy patients and was able to scope out the number of patients across the hospital, was to be able to show a need for the service. And so I established the physiotherapy vestibular clinic at the hospital and I’m now an advanced vestibular physio. So that’s all I do. And I guess I’m very lucky to have found this area of work. I’m very proud of what I’ve achieved. And in summary, I think it’s come about through a lot of hard work, but also a bit of luck along the way as well.

Clare Jones Gretta we could do an entire episode on what you’ve just talked about. And for women taking that career break and the challenges that brings and what it took for you to then forge your career from the ditch to an advanced specialist physio – that’s a whole series in itself. We should go back and explore this further in another episode. Now, can you give us just another brief summary of what a vestibular physio actually does? Because I find this quite fascinating.

Gretta Palmer Yeah, it is quite fascinating. And a lot of patients don’t actually know what a vestibular physiotherapist does either. So we treat a range of problems, dizziness and balance problems that are related to the vestibular system in the inner ear. So the vestibular system is located in our inner ear, and that’s where we get our sense of equilibrium or our balance from. And they’re pretty nifty, the vestibular system. They’re involved in everything that we do. So there are little movement sensors and they detect movement. They tell our brain what direction we’re moving in and how fast we’re moving. So for example Clare, if I was to put you on an office chair with a blindfold on and spin you around.

Clare Jones Please don’t. Please don’t. I’m someone who gets carsick. That’s my worst nightmare. But if you were to do that.

Gretta Palmer That would be one of your vestibular sensory organs that would tell your brain I’m being spun around to the right. Or, Danielle, if I put you in a lift with a blindfold on and push the button, it would be a different one of your sensory organs that would detect that movement. So they are involved in everything that we do. Really important for your balance. And also I explain it to patients, a vestibular system is like your little inbuilt steadicam in your head. It’s like this little vision stabiliser. It keeps everything really clear and steady while you’re walking around and while your head is moving. So just like you said, Clare, being on that office chair, being spun around would make you motion sick, for a lot of patients with vestibular problems, that is how they feel. Their whole world is like a bad home movie thing. As they walk around and they move their head, the whole world is moving it blurring and bobbing up and down. So, they actually feel very sick. They’re often off balance and it’s really distressing for them.

Clare Jones And debilitating, Gretta. I would imagine that, you know, it would be near impossible to work.

Gretta Palmer Yes. Yes.

Clare Jones With that feeling, let alone just functioning in everyday life.

Gretta Palmer That’s right. And so we use a range of different goggles and other specialised equipment to do tests. So it’s quite funny, patients come in with dizziness or vertigo, and they think that they have a problem with the inner ear. And then we start recording their eyes and putting these cameras and goggles on. And they look at me strangely and I don’t quite understand, you know, how it all is related, but it is a very interesting area of work.

Clare Jones So, Gretta, what are you looking for in eye movement? What’s the eye movement telling you?

Gretta Palmer So the vestibular system is like connected to the eyes through a reflex called the vestibular ocular reflex. So the eyes are like the window to the ears so we can see what’s happening for the vestibular system. And what we’re specifically looking at is nystagmus. So it’s an abnormal rhythmical beating of the eyes. And so we watch the eyes very carefully because it tells us really useful information about what is going on in the inner vestibular system.

Danielle Weedon And do you see patients acutely and chronically?

Gretta Palmer Yes. So part of the work I do and the role that I play in the hospital, is I visit all areas of the hospital, so dizzy patients present to emergency departments every day with the complaint of dizziness. So, I go to the emergency department and part of the role I play there is with the doctors. We are trying to differentiate benign peripheral causes of inner ear, vestibular, vertigo versus more serious, life threatening causes of dizziness and vertigo like a stroke, for example. And I guess just because you have dizziness doesn’t mean that it’s coming from a vestibular problem. Dizziness can come from lots of different causes.

Danielle Weedon Blood pressure, simple. Yeah.

Gretta Palmer Well medication side effects or blood pressure. And I’ve just mentioned a stroke, really serious, worrisome causes. And so that’s part of the role that I play in the hospital – trying to work out where this dizziness is coming from and if it is something inner ear related, then it’s amenable to vestibular rehab. And I can follow them up in the clinic. But I go to all areas of the hospital. I’m pretty much on a first name basis with all the specialty doctors and they really value my input into the management of these patients.

Danielle Weedon And what’s the history of vestibular physio? Has it always been around? And you said you discovered it yourself, if you like, ten years ago. But is it an emerging area of practice?

Gretta Palmer I didn’t learn about it at uni, but I guess the correct answer is, it just wasn’t embedded in the curriculum at that point because it has actually been around since about the 1950s. There were a couple of physios doing Cawthorn Cooksey exercises, which are a series of head and eye movement exercises, even back then. But it wasn’t until about the 1990s that there was really this, you know, a growing area. Doctor Susan Herdman, who’s a very well renowned physical therapist and her colleague, Dr. Neil Shepherd, became prolific in this area. So there’s really increasing strong evidence for the value of vestibular rehab and this growing area. There’s quite a few private vestibular physiotherapy clinics popping up, and vestibular physiotherapists are fast becoming the allied health or the health professional of choice to treat this imbalance problem.

Clare Jones And Gretta, this is another obvious question, but why are you so passionate about this area of practice

Gretta Palmer Well, you touched on it before Clare. Clear dizziness and vertigo is really distressing and really disabling. I mean, I don’t know if either of you have experienced it, but many of your listeners will have because it affects so many people. And so I guess as health professionals, we enter the profession because we like helping people. But dizziness and vertigo affects people’s work, it affects ability to drive, it affects their independence, their social interactions. And so I am able to help these people. And there are some conditions. Well, in fact, the most common condition I treat is BPPV or benign paroxysmal positional vertigo, and it’s caused by little particles in the inner ear that get dislodged and they get stuck in the wrong place. So that this problem where you have something stuck like a rock in your in your shoe, you know, you have to find it, shake it out. And so, if diagnosed correctly, BPPV can be treated in one session. So I have seen a gentleman who had had BPPV for ten years and he was a painter and he had had to give up work because he couldn’t get up a ladder and tip his head back to paint the ceiling. And I treated his vertigo in one session. And so that for me, was just a game changer, because there aren’t too many areas of physio that you can treat someone actively and totally in one session. And so that for me is the big thing, because I can make such a difference to these people’s lives. The other thing I love about my job now, and I also mentioned, is just the role I play in the hospital. So I’ve worked very hard to develop the credibility and the respect with the doctors, but they really value my input and so I’m very much involved in diagnosing and treating these patients. And although the role comes with a lot of responsibility because the stakes are pretty high, as I said, when I go to the emergency department and I’m saying to the doctors, I know this patient doesn’t need an MRI, this patient has vestibular neuritis. Refer them to me and I’ll follow them up in the clinic. You don’t want to get that wrong. So, it comes with a lot of responsibility. It’s quite challenging work. In fact, my brain hurts most days. But I do enjoy that. And vestibular physiotherapy is really a great mix of logic, and what I mean by logic is there’s lots of laws, there’s lots of rules, there’s lots of patterns that you learn in a vestibular anatomy and physiology, but it also is this great mix of that logic and creativity. So nothing ever is quite what it seems. You have to be a little bit creative in vestibular physio.

Danielle Weedon And for physios that are listening that might be interested in pursuing a career in vestibular physio, I know you said you did a lot of upskilling yourself, but what sort of advice could you offer around establishing a career in the area in terms of courses and PD?

Gretta Palmer So my first top tip would be to get a good background experience first. That’s not to say you can’t go straight into vestibular physiotherapy. You can. But I think it is good to have a good, well-rounded background knowledge, particularly in neurology. And so that was very helpful to me. I use those skills every day. There are a number of courses available these days, so I would recommend going on a basic two-day vestibular course first and then progression your way. There are even six-day week long competency based courses that you can take for vestibular. And the third thing I would recommend is getting a vestibular mentor, because I just know how many times I needed to read this stuff for it for it to sink in. Having a mentor, I have found really useful. And even as an experienced vestibular physio, I still surround myself with colleagues that you can ring and ask questions and say, Oh, hey, can you look at this video for me? What do you think? Does this make sense? And so, I still really value that vision.

Clare Jones And finally, Gretta, you mentioned how closely you work with doctors. Do other allied health professionals treat people with vestibular issues?

Gretta Palmer So I work very closely with audiologists. With hearing, the balance sensors are both located in the inner ear. So in addition to the hearing tests that audiologists are very well known for, some audiologists can do additional audio vestibular testing. And so that is really useful for us in the diagnostic workup when we’re trying to identify what the cause is. So, I do work very closely with audiologists and also psychologists. I have a few psychologists at the hospital that I refer to because it is so distressing, and it has such a big impact on their lives. And often after you’ve had a vestibular crisis, people develop secondary associated symptoms and they often develop depression and anxiety, or it exacerbates an underlying depression and anxiety. So, there are some vestibular disorders where having psychology input is really helpful.

Clare Jones When you mentioned the painter having suffered vestibular dysfunction for ten years, that was the first thing I thought of. I just thought from a mental health perspective, what an impact that must have had on his life, having to give up his work. And with that, you know, when you try and manage dizziness, there aren’t a lot of other jobs that you can do. There aren’t a lot of other options, I would imagine, other than sitting on a couch or lying in bed and just trying to leave the dizziness.

Gretta Palmer Yeah. As I said, the vestibular system is involved in everything we do, so it really is very disabling for patients.

Danielle Weedon Yeah, socially, like you mentioned as well, you know, if you’re not confident to go out and you can’t physically go out. It’s not just work that’s affected, it’s your social ability to socialise.

Clare Jones And falls risk too.

Gretta Palmer Yeah these patients are often very off-balanced, and having a vestibular problem places them at a higher falls risk.

Danielle Weedon It’s interesting. It’s like the area of chronic pain as well. It’s just that overlap of how debilitating it is to somebody’s life. And even if some of the patients that you say can be treated relatively quickly, there’s still the history of what they’ve had to manage socially, and work wise as well.

Clare Jones And trying to rebuild after the problems – rebuild their lives after problems fixed.

Gretta Palmer That’s right.

Danielle Weedon Thank you for joining us, Gretta. It’s been a very interesting conversation, and it’s always great to hear about the different career pathways available to clinicians. And I’ve no doubt your career story has inspired many of our listeners to explore options available to them in niche areas of practice. So, thanks again for joining us.

Gretta Palmer Thank you for having me.

Clare Jones Thanks, Gretta. It’s been fantastic.

Speaker We hope you enjoyed listening to the Allied Health Podcast. In the show notes, you’ll find links to our free recruitment resources, job opportunities, and healthcare marketplace insights. To listen to new episodes, please subscribe via Apple, Google or wherever you find your favourite podcasts. And if you’ve enjoyed the show, please give it a five star rating and review. And be sure to tell your therapy colleagues and friends to tune in.