Vestibular Classifications Flashcards
seated unsupported with eyes closed; PT asks patient to report any sensation of motion inside head, ask for description of motion.
Test name
Abnormal
Normal
test for sensation of motion at rest
normal: patient reports no sensation of motion
Abnormal: patient reports feeling motion
Observation: postural sway
Intervention for sensation of motion at rest: vestibular and somatosensory integration at rest
Setting: patient performs task with eyes closed with weights weighted blanket or heavy objects
-resting n legs
-axial loading with hands
Seated unsupported, turn head side to side eyes closed repeat with head nods up down
Test
Abnormal
Normal
Head motion provoked dizziness (Canal function)
normal: denies increase in symptoms
abnormal: pt reports dizziness or nausea
- asymmetry of information from inner ear canals or brain
What is intervention for head motion provoked dizziness (canal function)
rolling: supine to prone eyes closed
Head turns/EC
Spinning in circles: standing with eyes closed
instruct the patient to keep eyes focused on a target hold the head with both hands and quickly move head from neutral into rotation perform in both horizontal and vertical planes
test
abnormal
normal
Gaze stability
head impulse test: VOR
normal: eyes maintain on the target
abnormal: eyes slip off the target and require a catch up saccade to refocus on the target
passive head turns using a snellen chart at 1-3 Hz
test
normal
abnormal
Gaze stability with head turns
VOR
normal: letters stay in focus
abnormal: pt reports object blurs or slips loss of more than 2 lines of acuity on the snellen chart
pt to keep eyes fixed on a stable target while actively rotation the head side to side
Gaze stabiltity with head turns
VOR
normal: object stays visible
abnormal: object blurred
What is the intervention for impaired VOR gaze stability with head turns?
active head turns while attempting to fix eyes on stable target
progress speed, progress different angels
patient sits on tilt board with feet flat on board and hands on lap
PT manually tilts board from side to side perform EO EC
Otolith function: head righting response
abnormal: increased ankle strategy, hip strategy, use of arms, indicates patient has inefficient vestibular postural responses
What are interventions for impairment to otolith function: head righting response?
tilt board/rocker board
lateral reaching
tandem stance or tandem gait
2by 4
What three things could impact impaired postural control?
- vestibular
- somatosensory
- visual
Foam feet apart ,eyes closed, hands at side 30 sec hold
Pt responds with abnormal: excessive sway, inefficient ankle hip strategy
What sense is impaired on and intervention
impaired: vestibular
balance training on complaint narrow surfaces to decrease joint stiffness EC with without head motions altered or impaired visual input
2by4 training
stands on firm surface unsupported, feet together, eyes closed
pt responds with abnormal: loss of balance prior to 30 sec
impaired and intervention?
impaired: somatosensory
intervention: rocker board with ankle strategy
walking on uneven surfaces for ankle strategy practice
foam feet apart, eyes open, hands at side
abnormal response: LOB prior to 30 sec
reliance and intervention
reliance on Somatosensory
Intervention:
balance training on compliant narrow surface
eyes open–eyes closed
with and without head motion
feet together on firm surface with hands at sides, eyes closed
abnormal response: increased sway compared to eyes open sway pattern pt feels very off balance with eyes closed compared to eyes open
reliance: visual
intervention: balance tasks eyes closed: firm and progress to compliant surfaces
walking with head turns
smooth pursuits- follow moving target with eyes
seated: patient looks quickly between targets on command
seated: have patient perform tracking in all planes by following a slow moving target with their eyes
seated: patient focus on a target that PT moves from 10” away to <3” away
oculomotor testing
1. saccades
2. smooth pursuits/visual tracking
3. convergence/divergence
treatment if impaired: perform oculomotor task until symptoms provoked rest and repeat and tolerable
patient is seated in a swivel chair or stand ask the patient to watch themselves in a mirror while rotating torso repeatedly left/right patient is instructed to keep head straight perform with eyes open and closed
abnormal: head rotate with moving torso
cervicogenic dizziness
body rotation under stable head
intervention: laser and target
therapeutic exercise and manual therapy to correct cervical spine impairments
Symptoms of dizziness or nausea occur during oculomotor testing
Visual Motion Hypersensitivity
treatment: compensation: more time spent closing eyes during the day
decrease screen time
use of hat
adaptation: figure 8 blank background, standing
joint loading or increased surface area contact increase dizziness/nausea
Somatosensory Hypersensitivity
progressive and/or graded exposure to joint loading with increased surface area tactile input
beach walking
stomping on the ground
