Exam 2: Vestibular Intervention

Question 1

What are the five main interventions for vestibular therapy?

Answer 1

1. Canalith Repositioning Maneuver
2. Adaptation
3. Substitution
4. Habituation
5. Postural control and balance exercise

Question 2

How would you treat a posterior canalithiasis?

Answer 2

Epley’s

Question 3

How would you treat a posterior cupulolithiasis?

Answer 3

Liberatory Semont

Question 4

How would you treat a horizontal canalithiasis?

Answer 4

BBQ Roll

Question 5

How would you treat a horizontal cupulothiasis?

Answer 5

Gufoni

Question 6

What is adaptation in terms of vestibular rehabilitation?

Answer 6

Gaze stability (VOR) exercise to expose patients to retinal slip

Question 7

What condition is adaptation the primary intervention for?

Answer 7

Unilateral Vestibular Hypofunction

Question 8

What condition is adaptation the secondary intervention for?

Answer 8

Bilateral Vestibular Hypofunction

Question 9

What is the goal of adaption as an intervention?

Answer 9

Improve neuronal firing rate and balance of the vestibular system to reduce retinal slip

Question 10

What are the two main exercises for adaptation treatment?

Answer 10

VOR x 1 and VOR x 2

Question 11

Describe VOR x 1

Answer 11

Have the patient hold of their arm and look at their thumb. Have them move their head side to side as fast as they can while keeping the target in focus

Question 12

How fast should a patient ideally be able to turn their head while performing VOR exercises?

Answer 12

102 beats/minute

Question 13

Describe how to perform VOR x 2

Answer 13

Have the patient hold of their arm and look at their thumb and moves side to side. Patient should move their eyes and head in opposite directions while maintaining focus on the target

Question 14

Describe the progression of adaptation exercises

Answer 14

VOR x 1, change the position, distance, or background. Then progress to VOR x 2

Question 15

What are other examples of adaptation exercises?

Answer 15

Ball circles, football hike, balloon volley, wall roll, VR

Question 16

How often should a patient with acute UVH perform adaption exercies?

Answer 16

3x per day for 12 minutes total

Question 17

How often should a patient with chronic UVH perform adaptation exercises?

Answer 17

3-5x per day for 20 minutes total

Question 18

How often should a patient with BVH perform adaptation exercises?

Answer 18

3-5x per day for 20-40 minutes total

Question 19

What is the goal of substitution exercises?

Answer 19

Promote alternate strategies to substitute for impaired or lost vestibular function to improve postural and gait stability. Increase reliance on visual and somatosensory cues and cervical ocular reflex

Question 20

What condition is substitution the primary intervention for?

Answer 20

Bilateral Vestibular Hypofunction

Question 21

What condition is substitution the secondary intervention for?

Answer 21

Central Vestibular Pathology

Question 22

What is the dosage for substitution exercises?

Answer 22

3-5x per day for 20-40 minutes

Question 23

What are the two main exercises for substitution intervention?

Answer 23

Active Eye Head Movements and Imaginary Targets

Question 24

Describe how to do Active Eye Head Movements as a substitution intervention

Answer 24

Have the patient look at two targets an arms length away. Have them move their eyes to the other target followed by their head. Perform both horizontal and vertical

Question 25

Describe how to perform Imaginary Targets as a substitution exercise

Answer 25

Hold the target to the side and close your eyes. Turn your head and try to keep your eyes on the target

Question 26

How can you progress substitution exercises?

Answer 26

Sitting, standing, change the BOS, busy background

Question 27

What condition is habituation the primary intervention for?

Answer 27

Central Vestibular Dysfunction

Question 28

Describe habituation exercises

Answer 28

Exercises or movements that systematically expose the individual to a provocative stimulus that over time will lead to a reduction in symptoms

Question 29

Describe how to perform habituation exercises

Answer 29

Have the patient assume the position that evokes dizziness and hold until symptoms subside, return to neutral and wait 10 seconds or until symptoms reside, then repeat 5x

Question 30

What is the dosage for performing habituation exercises?

Answer 30

3-5x each session, 2-3x per day

Question 31

How long will it take for symptoms to subside with habituation exercises?

Answer 31

Two weeks

Question 32

What are some grounding techniques if habituation exercises flares up dizziness?

Answer 32

Sitting in a stable chair with feet, arms, and back supported, staring at a stationary object, controlled breathing, cold washcloth, peppermint

Question 33

What are two exercises for ocular muscular strengthening?

Answer 33

Pencil push-ups and Brockstring exercises

Question 34

How many minutes per day should patients perform postural control and balance exercises?

Answer 34

20 minutes per day

Question 35

What is the prognosis for UVH?

Answer 35

6-8 weeks. Can be less if acute

Question 36

What is the prognosis for BVH?

Answer 36

Up to 2 years

Question 37

What is the prognosis for BPPV?

Answer 37

1-2 treatment sessions

Question 38

What is the prognosis for Central Vestibular Dysfunction?

Answer 38

+6 months, may not completely resolve

Question 39

What are other prognostic factors for vestibular pathology?

Answer 39

Psychosocial factors, comorbidities, early intervention. There is no effect of age and gender