Vestibular Flashcards
What are clinical presentations of dizziness for cardiopulmonary/metabolic?
Syncope Orthostatic hypotension Cardiac arrhythmia COPD Anemia Hypoglycemia
What are clinical presentations of dizziness for Neuromuscular?
TBI/Concussion TIA/CVA Labyrinthits Neuritis Basilar migraine BPPV Multi-sensory Acoustic Neuroma Miners Disease MS Cerebellar atrophy
What are clinical presentations of dizziness for Musculoskeletal?
Cervical Dizziness
Temporomandibular Joint Dysfunction
Discuss signs, symptoms, and impairments of UVH, BVH, and BPPV. (5 general answers)
Disorientation to gravity Self motion intolerance Postural instability Gaze instability Sensory Conflict
What is exercise progression for UVH? (7 general answers)
Slow to fast movement
Wide to narrow base of support
Reaching outside BOS
Eyes open to eyes closed
Stable surface to complaint surface
Eye movement only to eye movement with coordinated head movement.
Walking with head stable on trunk to head moving on trunk.
Discuss signs, symptoms and impairments of Bilateral Vestibular Hypofunction
Presence of vertigo (depends on asymmetry)
Difficulty orienting to gravitational reference without vision
Motion discomfort; Slow head moving
Postural instability
Oscillopsia (Marced gaze instability)
Unsteadiness in complex motion environments
Intervention for Bilateral hypofunction?
Permanent use of visual
Cautious head movement
Safety
Encourage motion of individual in environment
Highly structured; individualized program
Target Postural and gaze instability
What is BPPV presentation?
Brief spells of dizziness
Nausea
Provoked by specific changes of head position
Consistent
Initial spell is not necessarily the worst
What are the impairments for BPPV?
Distorted response to specific head positions No space/ motion discomfort Mild postural instability Normal VOR Normal resolution of sensory conflict
What are interventions for BPPV?
Epley Maneuver (Ant & Post canal)
CRM (Horizontal canal)
Brandt-Daroff Exercise
Balance retraining
What examination tests are available for BPPV?
Dix Hallpike test (Ant & Post) Roll test (Horizontal) Balance Gait Fall risk
What are the Brandt-Daroff exercise guidelines?
5-10 repetitions; each rep 8-10 seconds.
2-3 times/ Day until symptom free
Symptoms resolve within 1-2 weeks
Symptoms should fatigue over reps and diminish over days.
Usually given has home exercise program; Specifically in session 2 of Clinical algorithm
What are the vestibular rehabilitation indications and contraindications for distortion (BPPV)?
Indications: Consistently provoked symptoms
Contraindications: Inconsistent symptoms
What are the vestibular rehabilitation intervention and goals for deficiency?
Intervention: Targeted exercise designed to promote Adaptation, substitution, and habituation.
Goal: Minimize symptoms, prevent or reverse maladaptive movement patterns, optimal function.
What is the difference between adaptation, substitution, and habituation?
Adaptation - recovery/restoration (use errors to change symptom; force brain to change)
Substitution - compensation (using alternative means to achieve therapeutic goals)
Habituation - desensitizing the body to symptoms; repeated exposure to a provocative (noxious) stimulus results in a pathological response over time
What are the vestibular rehabilitation indications and contraindications for deficiency?
Indications: Stable Pathology, provoked symptoms, and pre & post op
Contraindications: progressive, spontaneous symptoms, inconsistent symptoms
What are the 5 Fundamental Impairments of Vestibular Rehabilitation?
- Position tolerance: Perceptual disorientation relative to gravity (and position intolerance)
- Motion tolerance: Self-Motion discomfort (and intolerance)
- Postural Instability (VSR)
- Gaze instability (VOR)
- Sensory conflicts: Self vs Environmental Motion Conflicts - motion in the world around you can provoke symptoms
What are Vestibular Hypofunction Interventions? (3 general answers)
VOR Training
Habituation of head motion and position
Orientation and postural stability training
What are the 4 general rehab principles for UVH?
- Encourage movement
- Promote substitution in the short-term, adaptation in the long-term
- Gradually promote movement that minimizes compensatory patterns and is continuous and repetitive
- Be safe and compassionate.
How long does it take one with UVH to recover?
6 weeks to 6 months under normal conditions
Modifiers of UVH?
Willingness or ability to provoke symptoms (or low tolerance)
- High anxiety, agoraphobia, depressive disorder
- Fear of falling
- Other Cognitive / Behavioral impairments
Multiple vestibular diagnoses CNS Pathology Visual / somatosensory impairment Pre-existing eye movement disorder Cervical pathology / neck movement dysfunction Multiple medications Advanced age Progressive bifocal / trifocal glasses (may interfere with vision and vestibular adaptation)
What is the Dizziness Handicap Inventory (DHI)?
The patient is asked to answer each question as it pertains to dizziness or unsteadiness problems, specifically considering their condition during the last month.
Questions are designed to incorporate functional (F), physical (P), and emotional (E) impacts on disability.
To each item, the following scores can be assigned:
No=0 Sometimes=2 Yes=4
Scores:
Scores greater than 10 points should be referred to balance specialists for further evaluation.
16-34 Points (mild handicap)
36-52 Points (moderate handicap)
54+ Points (severe handicap)
When should you use Vestibular Adaptations for rehab?
UVH = Yes! BVH = Yes, but possibly due to a limited extent - focus more on substitution with BVH BPPV = No.
