Non-BPPV Interventions Flashcards
what is a medical emergency if this happens during eval or treatment?
sudden hearing loss
which non-BPPV diagnosis types have worse prognosis?
chronic
bilateral
which diagnosis is most responsive to treatment?
BPPV
which VOR disturbance usually resolves in a few days by itself?
static
which VOR disturbance is due to abnormality in VOR gain and abnormal input to vestibular nuclei?
dynamic
if vestibular symptoms don’t resolve spontaneously within ____, then the CNS is unable to modify/adapt on its own
4-7 days
adaptations require ____ signal to initiate neuroplastic adaptations
error
normal VOR gain
1
abnormal VOR gain
retinal slip
blurry images during head movement
oscillopsia
when do you know a treatment is too much?
image becomes blurry
during treatment, pt will experience sx but must attempt to continue exercises for _____ without stopping as long as ____
1 minute
target remains in focus (no blurry)
immediate effects of habituation
reduced sensitivity of Ca+ channels and release of NT
long-term effects of habituation
change in size and number of synapses
how is unilateral vs bilateral vestib hypofunction treated?
uni - adaptation
bi - substitution
what are the 4 exercise components to unilateral vestib hypofunction?
gaze stability (adaptation)
habituate
postural stability
endurance
what are the 4 exercise components to bilateral vestib hypofunction?
adaptation of remaining function
substitution***
postural stability
aerobic fitness
modifications to home and work
T/F: saccades and smooth pursuits can be done in isolation for hypofunction treatment.
F!!
red flags for vestib treatment
sudden hearing loss or fluctuation in hearing
increased pressure &/or fullness to point of discomfort
discharge of fluid from ear(s)
severe ringing in ear(s)
treat BPPV FIRST, then if symptoms still persist after ____ incorporate VOR
1-2 weeks
what are the VOR exercises for adaptation?
VOR x1
VOR x2
VORc
exercise rx for VOR adaptation exercises
1-2 min intervals
minimum of 3x per day
12 min = acute
20 min = chronic
sx provocation for 5-10 min post
what is VORx1?
focus on station target (14-pt x) at eye level for 1 minute with horizontal and vertical head movements at 2 Hz
what is VORx2?
head and target move opposite while eyes fixate on target
goal: 2 minutes at pt’s fastest speed
what is VORc?
eyes and head move in same direction as target
goal: 50 bpm for 2 mins
how far should the head be rotating during VOR exercises?
60 deg
what are the VOR substitution exercises?
active eye movements b/w 2 targets
remembered/imagined target
purpose of active eye movements b/w 2 targets
oculomotor substitute (saccade and smooth pursuit)
Rx for VOR substitution exercises
1 min at a time
3x per day throughout day
purpose of imagined target
cervical substitute for vestibular input
difference between VORc test and treatment
test - passive
treat - active
what is VORc?
pt actively move head and eyes in same direction as target
which exercises are indicated for all vestibular pt?
grounding/surface reorientation
esp. for non-BPPV
grounding/surface reorientation exercises
diaphragmatic breathing
box breathing
habituation exercises are indicated for
motion sensitivity
central vestib dysfunction
mixed vestib dysfunction
T/F habituation is a last resort
T
what maneuver is commonly done for habituation?
Brandt-Daroff
Rx for habituation
4 positions that provoke sx
2-3 reps of moving through them fast
2x/day for 8 weeks
for habituation, it may take up to ___ for sx to decrease
4 weeks
