Exam 2: Vestibular Intervention Flashcards
What are the five main interventions for vestibular therapy?
- Canalith Repositioning Maneuver
- Adaptation
- Substitution
- Habituation
- Postural control and balance exercise
How would you treat a posterior canalithiasis?
Epley’s
How would you treat a posterior cupulolithiasis?
Liberatory Semont
How would you treat a horizontal canalithiasis?
BBQ Roll
How would you treat a horizontal cupulothiasis?
Gufoni
What is adaptation in terms of vestibular rehabilitation?
Gaze stability (VOR) exercise to expose patients to retinal slip
What condition is adaptation the primary intervention for?
Unilateral Vestibular Hypofunction
What condition is adaptation the secondary intervention for?
Bilateral Vestibular Hypofunction
What is the goal of adaption as an intervention?
Improve neuronal firing rate and balance of the vestibular system to reduce retinal slip
What are the two main exercises for adaptation treatment?
VOR x 1 and VOR x 2
Describe VOR x 1
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
How fast should a patient ideally be able to turn their head while performing VOR exercises?
102 beats/minute
Describe how to perform VOR x 2
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
Describe the progression of adaptation exercises
VOR x 1, change the position, distance, or background. Then progress to VOR x 2
What are other examples of adaptation exercises?
Ball circles, football hike, balloon volley, wall roll, VR
How often should a patient with acute UVH perform adaption exercies?
3x per day for 12 minutes total
How often should a patient with chronic UVH perform adaptation exercises?
3-5x per day for 20 minutes total
How often should a patient with BVH perform adaptation exercises?
3-5x per day for 20-40 minutes total
What is the goal of substitution exercises?
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
What condition is substitution the primary intervention for?
Bilateral Vestibular Hypofunction
What condition is substitution the secondary intervention for?
Central Vestibular Pathology
What is the dosage for substitution exercises?
3-5x per day for 20-40 minutes
What are the two main exercises for substitution intervention?
Active Eye Head Movements and Imaginary Targets
Describe how to do Active Eye Head Movements as a substitution intervention
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
Describe how to perform Imaginary Targets as a substitution exercise
Hold the target to the side and close your eyes. Turn your head and try to keep your eyes on the target
How can you progress substitution exercises?
Sitting, standing, change the BOS, busy background
What condition is habituation the primary intervention for?
Central Vestibular Dysfunction
Describe habituation exercises
Exercises or movements that systematically expose the individual to a provocative stimulus that over time will lead to a reduction in symptoms
Describe how to perform habituation exercises
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
What is the dosage for performing habituation exercises?
3-5x each session, 2-3x per day
How long will it take for symptoms to subside with habituation exercises?
Two weeks
What are some grounding techniques if habituation exercises flares up dizziness?
Sitting in a stable chair with feet, arms, and back supported, staring at a stationary object, controlled breathing, cold washcloth, peppermint
What are two exercises for ocular muscular strengthening?
Pencil push-ups and Brockstring exercises
How many minutes per day should patients perform postural control and balance exercises?
20 minutes per day
What is the prognosis for UVH?
6-8 weeks. Can be less if acute
What is the prognosis for BVH?
Up to 2 years
What is the prognosis for BPPV?
1-2 treatment sessions
What is the prognosis for Central Vestibular Dysfunction?
+6 months, may not completely resolve
What are other prognostic factors for vestibular pathology?
Psychosocial factors, comorbidities, early intervention. There is no effect of age and gender
