lab 4: periperhal vestibualr hypofunction (PVH) treatments Flashcards
what are the 3 mechanisms of vestibular recovery
adaptation , substitution , and habituation
what is a recovering mechanism for VOR allows
system to make long-term changes in how it responds to input by utilizing remaining capabilities; involves combination of head movement & visual input to modify VOR gain; requires “error signal” to initiate neuroplastic adaptations
adaptation
If a patient is using a adaptation intervention they will experience symptoms but must attempts what
continues exercises for 1 full minute without stopping as long as the target remains in focus
If visual target becomes blurred during an adaptation exercises then ___
velocity of head movements, then
progress to full velocity (2Hz) under
varying task/environment demands and
increase duration to 1 min, then, 2 min.
decreased
what is Increasing utilization of other strategies to replace lost vestibular function; useful after bilateral VOR loss or with central dysfunction
or combination of peripheral & central dysfunction
subsitution
when is substitution used
after bilateral VOR loss or with central dysfucntion or combination of peripheral and central dysfucntion
what is Repeated exposure to a stimulus decreases brain’s pathological response to
that stimulus; brain gets used to it
habituation
for vestibular rehabilitation for peripheral unilateral hypofunction (NON BPV) exercises based w combination of what 4 exercise components
- exercises to promote gaze stability (adaptation)
- exercises to habituate symptoms of vertigo
- postural stability
- endrucnae
what are the treatment approached for peripheral bilateral hypofunction (non BPV)
- increasing function of nay remaining vestibular system via adaptation exerceis
- inducing alternative mechanisms to maintain gaze stability via substitution exercises
- improve postural stability durin head movement
- progressive aerobic fitness
-modifications of home
t/f: Clinicians should NOT offer
saccadic or smooth pursuit
exercises in isolation (without
head movement) as a specific
exercise for gaze stability to pts
with unilateral or bilateral
PVD/H/L
true
what exercises do you use for unilateral non BPV PVH
adaptation
what exercises do you use for bilateral non BPV PVH
substitution
what oculomotor exercises address CNS function but not vestibular ? and why does it not address vestibular
saccades, smooth pursuit , convergence , ocular ROM
bc there is no head movement
what are adaptation exercises for PVH/L
VOR
gaze stabilization
eye head coordination
when would u use adaptation exercises
for unilateral peripheral vestibular hypofunction
how many times should patients perform adaptation exercises
every day 3 x a day w intensity that makes pt dizzy but not sick
when should the speed of head movement be increased during adapatation exercises
as long as the target stays in focus and does not blur
how do u do VOR x1 as an adapatation exercises for unilateral hypofunction
head movement at 2Hz in horizontal or vertical planes from 1 min at a time while maintains focus on no a stationary target at eye level (if they can’t do 2Hz start at whatever they can tolerate)
what do u do if the pt is unable to perform VOR x1 as a adaptation exercise
start w ocular exercises alone from 1 min , 3x a day until able to do VOR
how should u start VOR x1
quiet environment , solid neutral background, pt sitting/standing on firm surface w wide BOS
how do u progress to VOR X2 for adaptation exercise
being able to do VOR 1 for 2 mins at a time
how to progress to VORc for adaptation exercises
progress to performing actively at 50bpm for 2 mins at a time
what must u explain as part of HEP for adaptation to occur
need to complete 1-2 mins intervals of VOR exercises a minimum of 3x per day
how long do u do VOR adaptation exercises for acute and chronic peripheral UVH
acute is 12 mins total
chronic is 20 mins
what is the 5 (to 10 min) rule
symptoms provocation which last 5-10 mins after stopping exercise is desirable
what are some progression variables for VOR exercises for adapatation
- speed
-duration
-amplitude
-target distance
-target size - VORx1 then VORx2
- multi task (add balance , cognitive task)
-direction (horizontal and vertical but can progress to diagnosable and angled positions
what would indicate you to use VOR substitution #1
severe bilateral peripheral vestibular loss
if there is any residual function what exercises (interventions) will u give the pt
adaptation exercises (VOR x1) and substitution exercise
what is VOR substitution #1
active eye head movement between 2 targets
how do u do VOR substitution #1 (active eye head movements between 2 targets)
goal is to keep target focuses
u have 2 targets on a wall and u have patient look at one target and the turn their head towards that target and then look at the other target and move their head towards that target
repeat for 1 min at a time and do at least 3x per day
what is the VOR exercises substitution #2
remembered or imagined target (stationary target)
how do u instruct the pt for VOR substitution #2 (remembered or imagined target)
tell pt to look and focus on a target at nose level , then tell them to close their eyes and turn head away from target while maintains eyes on the remember target
tell pt to open eyes and see if their eyes remembered the imagined target
asses accuracy and repeat for 1 min at a time so at least 3x a day
how do u progress Remembered or Imagined Target (Stationary Target)
more reps at 1 min at a time alone w varying other parameters
when would u used VORc exercise
chronic UVH pt
what is VORc managed by
by the vestibulocerebellum by inhibiting
the VOR gain during VORc.
what is an abnormal response to VORc
pt makes repetitive refixations (jerk nystagmus) during the middle of each rotation pass
how do u perfomr the VORc exercise
have pt actively move their eyes and head int he same direction as a moving object that they are tracking between their thumbs
work up to 1 min at a time , do 3x per day
to retain VORc start slow then progress to fast speed
what is the 5(to 10 min) rule for VORc exercise
symptoms provocation which last 5-10 min after stopping exercise is desirable
how can u progress VORc exercise
- direction
- postural support (seated > standing)
- background complexity (blank wall > busy wall)
- speed
- amplitude
- duration
what is the indication for habituation ? (not on practical)
for pt w motion sensitivity or central vestibular dysfucntion or mixed vestibular dysfunction
what is the goal of habituation
decreased stimulus response through repeated exposure to stimulus
what is a classic example of a habituation exercise
brandt-daroff
what is the most important intervention
patient education
what are the interventions for unilateral peripheral vestibular hypofunction that we are gonna do on the practical
- oculomotor exercises (only if eye movement alone provokes symptoms)
- VOR x1
- VOR x2
4/ VORc
in this sequence (adaptation exercises )
what are the interventions for bilateral peripheral vestibular hypofunction/loss (non BPPV) that we will do on the practical
- oculomotor exercises (only if eye movement alone provided symptoms)
- VOR x1 ( if residual function remaining) and active eye head movements between 2 targets PLUS remembered (imagined) targets
- VORc
what do u do if. a pateints has central vestibular dysfunction and eye movmeemtns alone cause dizziness in pts with known CNS (not on practical)
oculomotor exercises (ocular ROM , vengeance , smooth pursuit, saccades , VORc)
habituation exercises
gait and balance
progressive aerobic fitness program
