LAB 4: PVH Treatments Flashcards
Patient presents w unilateral,
3rd Degree, direction-fixed
nystagmus that increases with
gaze towards the fast phase,
and increases with Frenzels.
Patient actively having vertigo
and nausea. Diff Dx?
unilateral peripheral nonBPPV vestibular hypofunction
If VOR deficits, assess if it is ___ or ___
static
dynamic
examples of dynamic VOR deficit
loss of DVA
oscillopsia
deficit in VOR function:
static disturbance is seen when?
at rest in patients with acute unilateral dysfunction & typically resolves spontaneously within few days as CNS adjusts
deficits in VOR function: dynamic disturbances look like…
refers to abnormality in VOR gain or timing of eye
movements in relation to head movements caused by abnormal
input from vestibular nuclei
if someone has a unilateral VOR issue, what is goal?
ADAPTATION
*need to continue exercises for 1 full minute without stopping AS LONG AS TARGET REMAINS IN FOCUS
–when you see blurry, stop.
–if dizzy, its okay to keep going
If someone has bilateral VOR loss, systemic loss, central dysfunction…..what should main strategy for PT be?
substitution!
increase reliance on COR cervico-ocular reflex (feedback from neck proprioception can cause stereotypical eye mvmts but slower)
What is habituation?
repeated exposure to stimulus decreases brain’s patho response to stimulus: brain gets used to it
repeated provoking/stimulus until patients get used to symptoms
physiological reason for habituation
immediate: reduced sensitivity of Calcium channels, decreased neurotransmitter release
long term: change in size and number of synapses
CVD treatment
oculomotor exercises, habituation exercises
motion sensitivity treatment
habituation exercises
vestibular rehab for peripheral non BPPV (unilateral vestibular dysfunction)
- adaptation GAZE STABILITY EXERCISES
- habituation: optokinetic ex
- postural stability exercises
- aerobic
vestibular rehab for peripheral non BPPV (bilateral vestibular dysfunction)
- SUBSTITUTION: alternatives
- increase anything left with adaptation
- postural stability
- aerobic
- MODIFICATIONS of home and work
red flags of vestibular disorder treatment
- sudden loss of hearing/fluctuations of hearing
- increases pressure/fullness to point of discomfort
- discharge of fluid from ear
- severe ringing in ears
oculomotor exercises:
Saccades, Smooth Pursuit, Convergence, Ocular ROM
* Addresses CNS function, does not address vestibular (because there is no head movement)
- Intervention = dosed repetition of exam findings
VOR x1 progression:
at least 2 Hz for 2 minutes at a time
VOR x2
progress towards doing this for 2 minutes at a time
VORc progression
actively at 50 bpm for 2 minutes at a time
DOSING of HEP: need to complete 1-2 min intervals of VOR exercises a minimum of 3x/day,
for total of ___ min acute
for total of __ min chronic
for total of 12 min ACUTE peripheral UVH
for total of 20 min CHRONIC peripheral UVH
*otherwise adaptation will not occur
