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711 Adult Neurological Rehab > Vestibular and Balance > Flashcards

Vestibular and Balance Flashcards

1
Q

Balance is a skill that emerges from what 3 systems

A

Vestibular Visual Somatosensory

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2
Q

T/F Balance can improve with practice

A

True

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3
Q

Needs for balance control

A

Musculoskeletal components Internal representations Adaptive mechanisms Anticipatory mechanisms Sensory strategies Individual sensory systems Neuromuscular synergies

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4
Q

Berg Balance score for non-fall risk

A

> 45/56

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5
Q

Dynamic Gait Index

A

Assesses ability to modify balance while walking in the presence of external demands

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6
Q

Function of Vestibular system

A

Maintain equilibrium and balance

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7
Q

Signs and symptoms of vestibular impairment

A

Nystagmus Tinnitus Vertigo – room spins around pt. or pt. feels like they are spinning Hearing loss Loss of balance and possible falls Broad-based stance (to accommodate for imbalance) Sweating, nausea, and vomiting (due to ANS involvement)

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8
Q

Peripheral Vestibular System: Functions

A
  1. Stabilization of visual images on the fovea of the retina during head movement to allow clear vision 2. Maintain postural stability especially during movement of the head 3. Provide information used for spatial orientation
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9
Q

Peripheral vestibular system: Apparatus in inner ear

A

Semicircular canals (SCC) Utricle Saccule CN VIII: Vestibulocochlear nerve

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10
Q

Central vestibular system: Vestibular reflexes controlled by processes in ___________.

A

Brainstem

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11
Q

Central Vestibular System connections

A

Connections between the vestibular nuclei, reticular formation, thalamus and cerebellum

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12
Q

Central Vestibular System: Role of thalamus and cortex

A

arousal and conscious awareness of the head and body in space

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13
Q

Electro-oculography (ENG): Recording eye movements

A

– indirect method of using electrical fields changes to estimate the position of the eyes as a function of time - Use remote electrodes lateral and above and below the eye gives a representation of yaw and pitch eye movements, but not torsional

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14
Q

Video-oculography (VNG):

A
  1. Recording of eye movements – direct method of estimating the position of the eyes as a function of time 2. In a typical 2D system the video signals that show the complete eye movement
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15
Q

Caloric Irrigation Test

A

Cold/Hot water or air into ear to create nystagmus. Good to have response - vestibular system is working

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16
Q

Purpose of rotational chair test

A

determine whether or not dizziness may be due to a disorder of inner ear or brain, and particularly to determine whether or not both inner ears are impaired at the same time

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17
Q

3 Parts to rotational chair test

A

Chair test

Optokinetic test

Fixation Test

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18
Q

T/F: Persons with inner ear disease becomes LESS dizzy than a normal person during the chair test

A

True

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19
Q

Chair test

A

measures dizziness (well jumping of the eyes really – called nystagmus) while being turned slowly in a motorized chair

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20
Q

Optokinetic Test

A

measures dizziness caused by viewing of moving stripes

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21
Q

Test for bilateral vestibular loss and central conditions

A

Optokinetic Test

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22
Q

Does patient with bilateral vestibular loss ever experience dizziness?

A

No

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23
Q

Pt. has bilateral vestibular loss and closes their eyes, what will happen?

A

Fall backwards

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24
Q

Fixation Test

A

measures nystagmus while the person is being rotated, while they are looking at a dot of light that is rotating with them —. Fixation suppression is impaired by central nervous system conditions and improved by bilateral vestibular loss

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25
Q

Why perform ENG test and rotary chair test

A

Adds accuracy –ENG tests by themselves may be falsely positive or falsely negative. They can be falsely positive when wax blocks one ear canal.

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26
Q

T/F: Rotary chair test IS affected by mechanical block in the ear

A

False

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27
Q

Situation where ENG is false negative

A

Damage to each ear

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28
Q

Bony Labyrinth

A

3 semicircular canals, the cochlea and the vestibule. It is filled with perilymphatic fluid (similar to cerebral spinal fluid)

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29
Q

Membranous Labyrinth

A

is suspended within the bony section and contains membranous portions of the canals and utricle and saccule. It is filled with endolymphatic fluid (similar to intracellular fluid)

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30
Q

Motion Sensors in the ear

A

Ampulla and otolith organ

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31
Q

Ampulla

A

contain the cupula (hair cells) which convert displacement into neuro firing thru bending of hair cells to detect linear/angular motion

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32
Q

Otolith Organ

A

(Utricle and Saccule): contain calcium carbonate crystals called otoconia. Shift in these crystals set off neuro firing detecting gravity and acceleration

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33
Q

Rotation of head movements (GAIN) should be….

A

1:1 Abnormal gain can cause symptoms of blurry vision or vertigo

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34
Q

Head movements are detected by….

A

cupula and transmitted via Vestibular Nerve to the Brain. Which then controls eye movement to stabilize the gaze

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35
Q

Main vascular supplier to both central and peripheral vestibular system

A

Vertebral-basilar artery

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36
Q

Most commonly missed stroke

A

Cerebellar Stroke

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37
Q

VOR (Vestibular Ocular Reflex)

A

generates eye movements, which enables clear vision while head is in motion. Quick movement to see kids screaming

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38
Q

VSR (Vestibular Spinal Reflex)

A

generates compensatory body movement in order to maintain head and postural stability, thereby preventing falls

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39
Q

VCR (Vestibular Collic Reflex)

A

stabilizes the head in space

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40
Q

Function of vestibular system: VOR

A

stabilize vision when head moves

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41
Q

Function of vestibular system: Vestibular spinal reflex (VSR)

A

balance control

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42
Q

Visual requirements

A

Visual Acuity Position of image: Gaze Shifting Holding image steady: Gaze holding

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43
Q

Visual Acuity depends on

A
  1. Position of image on fovea 2. Ability to hold image steady
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44
Q

Shaking head up and down is called pitch and sensed by

A

anterior and posterior canals (ANGULAR VOR)

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45
Q

Shaking head side to side horizontally is called yaw and is sensed by..

A

Horizontal canals (ANGULAR VOR)

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46
Q

Angular VOR - sensory organs

A

Semi-Circular Canals: Horizontal Anterior Posterior

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47
Q

Linear or Translational VOR - sensory organs

A

Otoliths Saccule Utricle

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48
Q

Ocular Tilt Reflex - Sensory organs

A

Otolith Utricle

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49
Q

Migraines are peripheral or central?

A

Central

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50
Q

Motor output - Linear or translational VOR

A

Eyes move opposite to linear movement of the head. Linear movement up and down (riding in elevator) is sensed by the saccule. Linear movement horizontally (riding on a train on a straight track) is sensed by the utricle

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51
Q

Motor Output - Ocular Tilt reflex

A

Eyes and head move opposite to the tilt of the head. Tilt left causes elevation of the left eye, depression of the right eye, torsion of both eyes to the right and the tilt of the head on the body to the right.

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52
Q

3 Cervical reflexes

A
  1. The Cervicoocular Reflex (COR) 2. The Cervicocollic Reflex (CCR) 3. Cervicospinal Reflex (CSR)
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53
Q

The Cervicoocular Reflex (COR)

A

Weak reflex Does not play direct role in gaze stability May help VOR to compensate Proprioceptors and somatosensory receptors -C1-C2 dorsal nerve roots

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54
Q

The Cervicocollic Reflex (CCR)

A

Provides head stability Contraction of stretched muscles to align head

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55
Q

Cervicospinal Reflex (CSR)

A

-acts in conjuction with the VSR -provides postural stability through limb activation

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56
Q

Common Diseases of Dizziness and Imbalance - Peripheral

A

Vestibular Neuritis/labryinthitis Acoustic Neuroma Meniere’s Disease BPPV Toxicity

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57
Q

Common Diseases of Dizziness and Imbalance - Central

A

Disequilibrium of Aging CVA Migraine Head Trauma (TBI/Concussion)

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58
Q

Vestibular Neuritis

A

Key Features: Vestibular crisis (vertigo, imbalance, nausea) improving over 1-4 days, absence of associated auditory symptoms, left with head movement sensitivity Gradual and complete recovery is expected

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59
Q

Vestibular Neuritis Prognosis

A

Excellent with compensation, vestibular and balance rehab

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60
Q

Age commonly affected by vestibular neuritis

A

30-60

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61
Q

Maddox Rod testing - when line is to the left of the light

A

Exotropia Maddox rod used to detect troupe

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62
Q

Maddox Rod testing - when line is to the right of the light

A

Esotropia

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63
Q

Cover uncover test is used for

A

Tropia

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64
Q

Cover - cross cover test is used for

A

Phoria

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65
Q

Viral Endolymphatic Labryinthitis

A

Acute vestibular crisis lasting 1-4 days with a history and recovery similar to vestibular neuritis Key feature is a sudden hearing loss accompanied with vertigo. Hearing loss within a few hours before or after the onset of vertigo Hearing loss may recover or persist. If no vertigo reported suspect bilateral loss

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66
Q

Prognosis of viral endolymphatic labryinthitis

A

excellent for dizziness with compensation and vestibular balance rehab, need immediate steroid tx for hearing loss

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67
Q

Acoustic Neuroma

A

3rd most common intracranial tumor Nerve sheath benign tumors arise from Schwann cells lining the axons of the cochleovestibular n. Causes progressive unilateral hearing loss or tinnitus without vestibular symptoms. Balance issues (if present) tend to be mild and intermittent Rarely cause acute vestibular crises but may produce syndromes that mimic other vestibular diagnoses.

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68
Q

3 Therapeutic options for Acoustic Neuroma

A

watchful waiting, radio surgery, and surgical resection

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69
Q

Meniere’s Disease

A

A disorder of the inner ear function resulting in devastating hearing loss and vestibular symptoms. Unknown cause.

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70
Q

Key Features of Meniere’s Disease

A

Recurrent, spontaneous intense rotational vertigo persisting from 30 minutes to 24 hours, postural imbalance, nystagmus, nausea, vomiting, hearing loss, tinnitus and aural fullness.

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71
Q

Benign Paroxysmal Positional Vertigo

A

Most common cause of vertigo. Key features include brief episodes of vertigo when head is moved in certain positions. Symptoms are triggered by lying down, rolling over in bed, bending over, and looking up.

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72
Q

What is the most common single known cause of bilateral vestibulopathy?

A

Gentamicin toxicity, which is confirmed by rotary chair test. Symptoms include imbalance and visual symptoms. Visual symptoms include oscillopsia.

73
Q

Vertebrobasilar Vascular Insufficiency

A

Blockages of one or more arteries (either posterior inferior cerebellar a., vertebral a., anterior inferior cerebellar a., basilar a., and/or superior cerebellar a.) Symptoms include episodic vertigo with imbalance with other brainstem signs and symptoms, loss of coordination, ocular motor control deficits as well as postural control, gait and speech abnormalities.

74
Q

Treatment of Vertebrobasilar Vascular Insufficiency

A

Neurology, balance, gait therapy, and fall prevention, habituation if symptoms present

75
Q

What are people with migraines more likely to suffer from?

A

Severe motion sickness, Meniere’s Disease, or BPPV

76
Q

Migraine without Aura

A

Consists of periodic headaches that are usually throbbing and one sided, worse with activity, and associated with nausea and increased sensitivity to light and noise. Vertigo can occur before, during or separately from the episodes of migraine headache

77
Q

Migraine with Aura

A

Associated with short lived symptoms (noises, flashes of light, tingling, numbness, vertigo and others) known as the aura. Symptoms usually precede the headache and usually last 5-20 mins

78
Q

Basilar Migraine

A

Symptoms include vertigo, tinnitus, decreased hearing and ataxia (loss of coordination)

79
Q

Triggers of migraines

A

Stress, anxiety, hypoglycemia, fluctuating estrogen, certain foods, smoking and other factors

80
Q

Concussion Signs and Symptoms

A

Physical: headache, balance problems, light/noise sensitivity, blurred vision, dizziness, fatigue, nausea Cognitive: mentally foggy, difficulty concentrating, confusion Emotional: irritability, sadness, nervousness, anxiety Sleep: drowsy, altered sleep patterns Duration of Symptoms is highly variable and may last from several minutes to months or even longer in some cases

81
Q

Ocular Motor Findings after Concussion

A

Pursuits: “Saccadic” pursuits or “Saccadic Intrusions” Symptomatic w/ pursuit movements Saccades: Hypometric Saccades Slowed Saccades Symptomatic with saccades eye movements

82
Q

Meniere’s Disease Key features

A

A disorder of the inner ear function resulting in devastating hearing loss and vestibular symptoms Key Features: recurrent, spontaneous spells intense rotational vertigo lasting several hours, postural imbalance, nystagmus, nausea, vomiting, hearing loss, tinnitus and aural fullness. Vertigo will persist anywhere from 30 mins to 24 hours.

83
Q

Meniere’s Disease Cause

A

Cause of disease is unknown. Hereditary factors may play a role. Usual onset in the 4th and 6th decades of life, equally between the sexes

84
Q

How many days until ambulatory with Meniere’s Disease

A

3 Days.. Symptoms gradually abate, usually ambulatory within 3 days. Some sensation of unsteadiness will persist but then normal balance returns between spells

85
Q

Saccadic Pathway

A

Front cortex–Frontal eye field (FEF) Dorsal lateral prefrontal cortex Superior Colliculus (SC) Brainstem Posterior parietal cortex (PPC)

86
Q

Pursuit Pathways

A

(overlap with saccadic movement) FEF PPC Cerebral structures Medial temporal and medial superior temporal cortex

87
Q

Vergence System

A

Moves the eyes in opposite direction to align foveas on the same object in space. Responsible for near to far bilateral disconjugate eye movements. Stimulus for a vergence response: double vision or different positions of image on the retina, which creates a “fusional vergence movement”

88
Q

Convergence

A

Ability of eyes to turn inward to focus on a near target. Response = Visual signal from occipital cortex to vergence premotor neurons in midbrain reticular formation to midbrain CN III to TRIAD Triad: (1) convergence leads to: (2) accomodation leads to: (3) miosis of the pupil

89
Q

Vergence Testing

A

Patient fixates on target brought in along the mid-sagittal plane toward the nose • Near Point of Convergence: when target becomes double • Normal NPC

90
Q

Vergence Dysfunction Symptoms

A

Asthenopia when reading, frontal headaches, intermittent or constant double vision, squints (closes one eye), letters will appear to float or move around the page, lack of symptoms but findings persist (suppression, avoidance, or occlusion)

91
Q

Conjugate Movements

A

EOM movement, Saccades, and Pursuits

92
Q

Disconjugate Movements

A

Convergence and Divergence

93
Q

Tropia

A

Overt deviation of the eye. Exo - outward (laterally) Eso - inward (medially) Hyper - upward Hypo - downward

94
Q

Phoria

A

Ocular deviation occurs when dissociation occurs

95
Q

Misalignment Symptoms

A

Severe = diplopia, head tilt (vertical misalignment), noticeable eye turn Subtle = difficulty maintaining focus, cosmetically normal, ocular soreness, headaches, mental dullness

96
Q

Orthostatic Hypotension or Intolerance

A

Symptoms of dizziness: Faintness or lightheadedness which appear only in standing, and which are caused by low blood pressure, Only rarely is spinning vertigo caused by orthostatsis, Chest pain, Sweating/nausea

97
Q

Ramsay Hunt Syndrome

A

Herpetic infection of the VII and VIII CN. Sudden onset of pain with open sores, loss of hearing with a vestibular crisis event, facial mm weakness. Treatment: medical antiviral with steroids Prognosis: usually left with hearing loss and needs vestibular balance rehab

98
Q

Arnold Chiari

A

Episodic to continuous imbalance and lightheadedness exacerbated by hyperextension of neck, double vision on lateral gaze. Down beating nystagmus in primary gaze usually exacerbated with lateral gaze. Treatment: neurology/neurosurgery Prognosis: post surgery gait and balance therapy

99
Q

Multiple Sclerosis

A

5-7% will have true vertigo as initial onset symptom. Others will have lightheadedness or imbalance. Shows central signs of saccades and pursuit abnormalities, nystagmus. Treatment: neurological care/vestibular rehab may be useful in exacerbations for imbalance and habituation to motion sensitivity

100
Q

Peripheral Disorders

A

Vestibular neuritis, labryinthitis, acoustic neuroma, toxicity, BPPV, and Meniere’s disease

101
Q

Central Disorders

A

Disequilibrium of aging, CVA, Migraine, and head trauma

102
Q

Questionnaires (examining vestibular system)

A

Dizziness Handicap Inventory (DHI), Activities of Balance Confidence Scale (ABC), Visual Vertigo Analog Scale, Situational Vertigo Questionnaire

103
Q

What is the most important part of the evaluation?

A

History

104
Q

Symptoms of Dizziness

A

Vertigo, imbalance (general or actual ataxia with possible falls), lightheadedness, or a combination of these.

105
Q

Objective Tests/Measures of the Vestibular System

A

Cervical ROM/cervical instability, gross strength and mobility, ocular motor system, special tests, and balance assessment

106
Q

Joint Position Error Test (JPE)

A

Patient is seated 3 feet away from a target and uses a laser pointer strapped to the patient’s head and patient will close eyes and look either right/left/up/down and then back to the center to measure joint position error. Error > 4.5 degrees are likely significant for head and neck position sense/proprioception.

107
Q

5 Red Flags during the Vertebral Artery Test

A

Diaphoresis, dysphagia, dysarthria, drop attacks, and diplopia

108
Q

CN Screening 1-6

A
  1. Olfactory: smell 2. Optic: vision (chart, peripheral) 3. Oculomotor: eye movement (dilation of pupils, follow target) 4. Trochlear: eye movement down 5. Trigeminal: facial sensation/chewing 6. Abducens: eye movement laterally
109
Q

CN Screening 7-12

A
  1. Facial: expression and taste 8. Vestibulocochlear: hearing and balance 9. Glossopharyngeal: swallowing and speech 10. Vagus: swallowing and speech 11. Accessory: muscle control, shoulder shrug 12. Hypoglossal: tongue movement
110
Q

Eye movements are controlled by…

A

Saccadic, smooth pursuit, vestibulo-ocular, vergence

111
Q

Spontaneous Nystagmus

A

Holding pt’s head still while looking straight ahead, observe for nystagmus

112
Q

Fixed Gaze Nystagmus

A

pt’s head still, have pt look 30 degrees left, right, up and down from center and hold gaze. Observe for nystagmus

113
Q

Oculomotor ROM

A

18-24” from pt, eyes should move smoothly and together

114
Q

Convergence

A

pt focus on finger until diplopia or blurry vision; should be 5-8cm from brow

115
Q

Positive Test for Saccades

A

Overshoots

116
Q

Cover-Uncover Test

A

Tests for tropia if there is movement

117
Q

Cover-Cross Cover Test

A

Tests for phoria or measures magnitude of phoria or tropia

118
Q

Maddox Rod

A

Always test the right eye! .5” or less is normal deviation of the line

119
Q

VOR Cancellation

A

Tilt pt’s head down 30 d; have pt hold thumbs in front of them. PT move head/hands in same direction. + saccadic eye movement

120
Q

VOR

A

Tilt pt’s head down 30 d, move head side to side while they look at your nose

121
Q

Head Thrust Test

A

+ test indicates vestibular hypo function on ipsilateral side

122
Q

Head Shaking Nystagmus

A

+ nystagmus suggesting unilateral vestibular hypofunction

123
Q

Visual Acuity

A

2 line difference is normal; 3+ is abnormal

124
Q

Tragal Pressure

A

+ nystagmus or increased dizziness

125
Q

PT Goals, Outcomes,

A

Safety: sensory substitution, compensatory strategies, AD

126
Q

Exercises to promote vestibular adaptation

A

Habituation training, gaze stability exercises, postural stability exercises, emphasize functional mobility skills, relaxation training

127
Q

PT Treatment Principles

A

Adaptation, Substitution, Habituation

128
Q

Goals of Compensation

A

Normal gaze stability and postural control Reprogram eye movements and postural responses Movement/exposure to stimuli that challenge system Error signal to brain so it can reset

129
Q

VORx1

A

side-to-side eyes on stationary target

130
Q

VORx2

A

side-to-side eyes on moving target

131
Q

BPPV stands for?

A

Benign paroxysmal postitional Vertigo

132
Q

BPPV symptoms

A

Starts suddenly describe vertigo with tilting of head, looking up and down, rolling over in bed nausea and vomiting NO HEARING LOSS OR TINNITUS

133
Q

How is BPPV diagnosed?

A

Head CT scan MRI Dix-Hallpike (Hallpike-Dix) along with patient history

134
Q

Dix-Hallpike Test looks for?

A

Anterior and posterior canal issues

135
Q

Roll Test for?

A

Horizontal Canal

136
Q

Treating BPPV

A

medications Canalith Repositioning Procedure Surgery

137
Q

What to consider before thinking BPPV?

A

Cervical ROM Vertebral Artery Compression Functional Status Standardized test and measures (Dizziness Handicap Inventory) Medical interventions (Vestibular suppressant medications)

138
Q

Precautions for testing BPPV

A

cervical spine instability prolapsed intervertebral disc cervical myelopathy Arnold Chiari malformation Vascular dissection syndromes Previous cervical spinal surgery Carotid sinus syncope Aplasia of odontoid process

139
Q

Canalithiasis

A

Debris floating freely in the endolymph in the long arm of the semi circular canal

140
Q

Cupulolithiasis

A

Debris, probably fragments of otoconia from the utricle, adhere to the cupula

141
Q

Canalithiasis Theory

A

Otoliths become dislodged from the utricle & enter the Posterior SCC (most dependent of the 3 SCCs)

142
Q

Canalithiasis Symptoms

A

nystagmus under 60 seconds

143
Q

Cupulolithiasis Symptoms

A

nystagmus over 60 seconds

144
Q

Treating Canalithiasis

A

Canalith repositioning maneuver/procedure (Epley) 84-90% remission rate Sleep upright for one night

145
Q

Children with canalithiasis

A

Extremely rare with youngest at 5 years old. Age is a determining factor

146
Q

Right Posterior Canal nystagmus

A

Cupulolithiasis – Persistent UBN & R Torsion Canalithiasis – Transient UBN & R Torsion

147
Q

Left Posterior Canal nystagmus

A

Cupulolithiasis – Persistent UBN & L Torsion Canalithiasis – Transient UBN & L Torsion

148
Q

Horizontal ageotrophic is which?

A

Cupulothiasis

149
Q

Horizontal geotropic is which?

A

Canalithiasis

150
Q

Right Anterior canal nystagmus

A

Persistent DBN & R Torsion

151
Q

Left anterior canal nystagmus

A

Persistent DBN & L Torsion

152
Q

Cupulolithiasis

A

No latency Weak nystagmus (about 5 deg/sec), directed about the axis of the canal being stimulated. Cupulolithiasis might occur in any canal – horizontal, anterior or vertical, each of which might have it’s own pattern of positional nystagmus. For the lateral SCC, the nystagmus is ageotropic, meaning that it beats upward with respect to the head position.

153
Q

Assessment and treatment of BPPV

A

Dix-Hallpike (Posterior/Anterior Canal) Roll Test (Horizontal Canal) Maneuvers for repositioning

154
Q

What are the Dix-Hallpike Test steps?

A

Patient sits on table Clinician turns patient’s head horizontally 45 degrees and quickly moves patient down to supine position with neck extended 30 degrees beyond horizontal. Check for symptoms (Vertigo & Nystagmus) Return patient to sitting & test other side Positive for BPPV on side that produces symptoms

155
Q

What are the Roll Test steps?

A

Patient’s head is placed in 20 degrees of cervical flexion on a wedge Head is turned 90 degrees to the L – check for nystagmus & vertigo Turn head gently to neutral starting position Test is repeated to other side & PT again checks for nystagmus & vertigo

156
Q

Treatment options for BPPV in physical therapy

A

CRP (Ant/Post Canalithiasis) Semont or Liberatory Maneuver (Ant/Post Cupuloithiasis) Epley * only if use vibration to mastoid area Barbeque roll (Horizontal Canalithiasis) Semont maneuver as modified by Casani (HC Cupuloithiasis) Appiani (HC Canalithiasis) Brandt Daroff Habituation Exercises- use as last resort

157
Q

Epley’s maneuver or Canalith repositioning procedure

A

Treatment of choice Patient is positioned in a series of steps so as to slowly remove the otoconia particles from the posterior SCC back into the utricle Takes about 5 minutes One week after CRP procedure, repeat the Dix-Hallpike test IF the patient does experience vertigo and nystagmus, the CRP test is repeated and can add vibrator placed on the skull to better dislodge the otoconia (true Epley)

158
Q

Canal Repositioning procedure

A

1) Turn head to 45 degrees to involved side 2) Patient then reclines to supine with 20-30 degrees cervical extension 3) Hold for 30-60 seconds 4) Turn head 90 degrees away from affected ear 5) Patient then rolls onto shoulder toward the head 6) Patient’s head sould be 45 degrees to floor facing shoulder 7) Patient then sits up with examiner holding patient for a minute

159
Q

Semont Liberatory Maneuver

A

Position 1. Patient is made to sit on the examination table with legs hanging over the edge and head turned 45 degrees horizontally towards the unaffected ear. Position 2. While maintaining head rotation patient’s upper body is swiftly moved to side lying position on the affected side with head resting on examination table and nose pointed upwards. Position is maintained for 3 minutes or till vertigo and nystagmus subsides. This step moves the debris to the apex. Position 3. Patient is rapidly moved through the sitting position (Position 1) to lying on the opposite or unaffected side (maintaining same head rotation) with nose pointed to the ground. Position is again maintained for 3 minutes or till the vertigo and nystagmus subsides. This maneuver moves the debris towards exit of the canal.

160
Q

Casani treatment

A

Patient is taken into sidelying toward the Involved side Maintain neutral cervical rotation – hold 1 min. Cervical spine is then rotated downward – hold for 1 min after end of nystagmus. Patient returns to sitting.

161
Q

Appiani treatment

A

Patient is taken into sidelying toward the uninvolved side Maintain neutral cervical rotation – hold 1 min. Cervical spine is then rotated downward – hold for 1 min after end of nystagmus. Patient returns to sitting.

162
Q

Barbecue Roll treatment

A

Begin patient in supine position Patient rolls towards unaffected ear. Patient continues to roll “barbecue” style. Patient continues to roll until reaching the starting position. Rolls are 90 degree increments and the procedure is repeated 2-3 times until the patient is symptom free.

163
Q

Brandt-Daroff Exercisises: HEP

A

Start in an upright, seated position. Move into the lying position on one side with your nose pointed up at about a 45-degree angle. Remain in this position for about 30 seconds (or until the vertigo subsides, whichever is longer), then move back to the seated position. Repeat on the other side.

164
Q

Adaptation

A

Error signal sent to brain; brain tries to reduce it. Vestibular system is frequency specific and have to advance head frequencies and head positions

165
Q

Adaptation Exercises

A

VOR x1 and x2 Exercises. Progress: duration, velocity, busy backgrounds, position, target distance.

166
Q

Substitution

A

Use other strategies to replace lost/impaired function. Eye tracking, oculomotor exercises and saccades.

167
Q

Substitution Protocols

A

Strengthen weakened system to return to function by challenging remaining ones. Progress from easy/static EO/EC to difficult/dynamic EO/EC

168
Q

Substitution Exercises

A

Eye and head movements between 2 targets Remembered target practice

169
Q

Habituation

A

Systematically provoke symptoms to produce reduction in those symptoms.

Pick 2 or 3 of the worst provoking maneuvers as basis of tx. pt performs up to 5 reps, once or twice daily.

170
Q

Habituation Training

A

Repetition of movements and positions that provoke dizziness and vertigo

171
Q

Postural Stability Exercises

A

Static or Dynamic balance exercises:

Bending forward, turning, walking, walking & turning, walking with head turns.

Emphasize functional mobility skills: community activities, activities with spatial and timing constraints.

172
Q

Vestibular Recovery Rates

A

UVL: 6-8 wks

BPPV: Remission in 1/few tx

BVL: 6 months - 2 years

CNS Lesion: 6 months - 2 years

173
Q

Vestibular Exercise Program Objectives

A

Diminish dizziness and vertigo

Enhance gaze stabilization

Enchance postural stability in static/dynamic situations

Enhance overall functional activity

Patient Education

174
Q

Vestibular Program Components

A

Gaze stabilization to retrain VOR

Balance retraining to retrain VSR

Conditioning exercises to increase fitness level

Habituation or canal repositioning maneuvers as indicated

175
Q

PT Interventions

A

Outpatient: 1-2 times/week (4-6 weeks)

HEP: 5 min, 3x/day

Walking program (health and fitness)

Compliance is essential for success

176
Q

Convergence Exercises

A

Pencip Push Ups

Brock String

Arrow Chart/Dot Chart

177
Q

Accommodative Exercises

A

Heart Chart

178
Q

Cervical Proprioceptive Exercises

A

Head laser with targets

Combine with saccades

Eyes closed awareness

711 Adult Neurological Rehab (12 decks)

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