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6 Neurological Dysfunction > L4 Vestibular Treatment > Flashcards

L4 Vestibular Treatment Flashcards

1
Q

What is the goal of vestibular rehab?

A

optimize patient recovery by addressing gaze stability, motion sensitivity, and postural stability deficits through customized therapeutic exercise and patient eduction

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2
Q

Potential impacts of vestibular impairment on function

A
  1. unsteadiness and balance impairments that worsen with dimly lit surroundings or uneven surfaces
  2. Dizziness exacerbated by riding in a vehicle, positional changes, visually busy environments
  3. Patinets may limit head and neck movements to help decrease exacerbation of S/S, leading to secondary impairments
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3
Q

Otolith demineralization

A

of otoconia in saccule and utricle is decreased
earliest change seen

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4
Q

Hair cell degeneration and loss

A

occur after age 50
hair cell density has more of a decrease in the saccule and cristae ampullaris

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5
Q

Over the age of 55,

A

impaired vestibular dysfunction can be seen in the decline in VOR function

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6
Q

Vestibular adaptation

A

recovery mechanism of the VOR
allows the vestibular system to make long-term improvements in how it responds to input to capitalize on remaining capabilities

goal is to rebalance the baseline firing rate within the peripheral vestibular system

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7
Q

Substitution exercises

A

use of other strategieis to replace the lost function, not classified as a true mechanism of recovery

increased reliance on visual and somatosensory inputs

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8
Q

Habitutaion exercises

A

provoking position or stimulus is repeated until the person no longer has symptoms

relies on the principle that repeated exposure decreases the brain’s pathological response to the stimulus

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9
Q

Canalith repositioning maneuvers

A

series of positions designed to remove the dislodged otoconia from the SC to treat BBPV

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10
Q

Comprehensive Treatment Activities

A
  1. Vestibular Adaptation
  2. Substitution exercises
  3. Habituation exercises
  4. Canalith repositioning maneuvers
  5. Balance exercise
  6. Aerobic exercise
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11
Q

Stable unilateral deficit

A

very good candidates for vestibular rehab using adaptation techniques

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12
Q

Stable bilateral deficit

A

treatment with habituation or substitution

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13
Q

Unstable unilateral or bilateral deficit

A

not good candidates for vestibular rehab
medicine, lifestyle changes, rest

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14
Q

Central vestibular deficit

A

treatment uses substitution and habituation

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15
Q

VOR gain

A

the ratio used to describe the relationship of eye movement to head movement

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16
Q

Retinal slip

A

occurs when VOR gain is impaired

movement of the visual image on the retina during head movement that causes the image to become blurry or jump

17
Q

Adaptation Exercises Goal

A

create a retinal slip and utilize that error signal to modify the gain of teh VOR

incorporates visual stimuli with head movement

18
Q

Gradual increasing retinal slip

A

more effective than producing larger errors

repeated exposure to retinal slip during gaze stabilization activities allows for vestibular adaptation

19
Q

Adaptation Exercises may cause the patient to

A

experience their symptoms

important to establish a baseline of what S/S your patient has

treatment should be titrated so as to not increase your patients S/S more than 3 points above their baseline

Residual symptoms should not last more than 10 min

19
Q

How to progress and regress Adaptation exercises

A

position changes: sitting/standing
incorporate movement
change background
vary speed of head movement
vary ROM

20
Q

Goal of habituation exercises

A

reduce response to stimuli
will not change the VOR gain

21
Q

Creating habituation intervention

A

-appropriate for pts with CNS dysfunction, BVH, unilateral vestibular hypofunction
-make sure to perform a subjective exam to know what actions make their S/S worse, then use that to create an exercise
-choose up to four movements that cause the patient to have S/S during testing, the pt is to perform those throughout the day
-it will take about 4 weeks for S/S to decrease

22
Q

Goal of substitution exercises

A

promote the use of alternative strategies to substitute for impaired vestibular function

help the pt maintain gaze stability

23
Q

Benign Paroxysmal Positional Vertigo

A

-mechanical problem of inner ear caused by dislodged otoconia from the utricle making their way into the semicircular canals
-about 20-30% of patients that are seen for vertigo have BPPV

24
Q

Canalithiasis

A

otoconia are free floating in the canal
most common type of BPPV

S/S will be short lived
S/S will cease once debris settles in most dependent portion of canal

25
Q

Cupulolithiasis

A

otoconia adhere to the cupula of the crista ampullaris
vertigo doesn’t go away for a few minutes

cupula becomes relatively heavy in endolymph and will persist as long as the individual is in the provoking position

26
Q

BPPV presentation

A

vertigo lasting 30s to 2 minutes after positional change
normal vestibular and oculomotor exam

27
Q

Causes of BPPV

A

-usually idiopathic
-most common after head trauma, illness, ischemia of anterior vestibular artery

common in older adult population due to degenerative changes of inner ear

28
Q

Horizontal Canal Canalithiasis Treatment

A

lemper roll/BBQ roll
gufoni maneuver for geotropic nystagmus

29
Q

Horizontal cupulothiasis treatment

A

gufoni maneuver for apogeotropic nystagmus
rapid head shaking

30
Q

Canalithiasis treatment (A/P canals)

A

modified epley

31
Q

Cupulolithiasis A/P canals treatment

A

semont

32
Q

Smooth pursuit results

A

CNS = saccadic intrusions
PNS = normal
BPPV = normal

33
Q

Saccades results

A

CNS = dysmetria/overshoots
PNS = normal
BPPV = normal

34
Q

Gaze holding nystagmus results

A

CNS = direction changing
PNS = increased beating away from lesion or normal
BPPV = normal

35
Q

VOR Test results

A

CNS = normal
PNS = lose gaze fixation
BPPV = normal

36
Q

Head Thrust Test Results

A

CNS = normal
PNS = catch up saccade in side of movement
BPPV = normal

37
Q

Head Shake Test results

A

CNS = normal
PNS = nystagmus to opposite side of lesion
BPPV = normal

38
Q

VOR Cancel Test

A

CNS = eyes not following thumbs, saccadic intrusions
PNS = normal
BPPV = normal

6 Neurological Dysfunction (16 decks)

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