Vestibular Disorders

Question 1

What are VRT exercises useful for?

Answer 1

They are useful for both peripheral and central vestibular disorders that benefit from movement retraining.

Question 2

What is the purpose of VOR x 1 exercise?

Answer 2

To improve visual acuity and decrease blurring of the head with movements.

Question 3

What is the primary goal of VOR x 2 exercise?

Answer 3

To train the patient to maintain focus on a moving target while the head is moving in the opposite direction.

Question 4

How should VOR exercises be performed for effectiveness?

Answer 4

They should be performed at a challenging speed where the target can still be kept in focus with effort.

Question 5

What is the role of retinal slip in VOR exercises?

Answer 5

It creates an error signal to the brain, leading to recalibration and improvement of the VOR.

Question 6

What is the importance of gaze shifting exercises?

Answer 6

They are easier for some patients to tolerate and are useful for severe vestibular loss.

Question 7

What are 2 Target VOR exercises?

Answer 7

Exercises where the patient alternates focus between two targets, moving eyes first, then the head.

Question 8

What is the purpose of habituation exercises?

Answer 8

To reduce symptoms by repeated exposure to movements that produce dizziness, leading to desensitization.

Question 9

Who benefits most from habituation exercises?

Answer 9

Patients with motion sensitivity after a vestibular problem, especially in subacute/chronic stages.

Question 10

What is the typical prescription for habituation exercises?

Answer 10

3-5 repetitions of the provoking movement, 3-5 times a day, with pauses for symptoms to subside.

Question 11

What are static balance activities for vestibular patients?

Answer 11

Balancing without upper extremity support, ball toss, weight shifting on various surfaces.

Question 12

What are some dynamic balance activities for vestibular patients?

Answer 12

Gait with head turns, eyes open/closed, multidirectional stepping with head turns.

Question 13

What does the Clinical Practice Guideline (CPG) say about VRT outcomes?

Answer 13

There is strong evidence that VRT improves outcomes, especially with earlier intervention.

Question 14

What is the recommended gaze stability dosage for acute/subacute UVH?

Answer 14

3-5 times per day, with a total of 12 minutes per day for 4-6 weeks.

Question 15

What is the recommended gaze stability dosage for chronic UVH?

Answer 15

3-5 times per day, with a total of 20 minutes per day for 4-6 weeks.

Question 16

What is the recommended gaze stability dosage for BVH?

Answer 16

3-5 times per day, with a total of 20-40 minutes per day for 5-7 weeks.

Question 17

What balance exercise dosage is recommended for chronic UVH and BVH?

Answer 17

20 minutes per day for 4-9 weeks.

Question 18

Why is patient education crucial in vestibular rehabilitation?

Answer 18

Educating the patient on the importance of the exercises and how they contribute to recovery.

Question 19

How should patients be educated about provoking dizziness during exercises?

Answer 19

Explain that dizziness is part of the process and should subside quickly after the exercises.

Question 20

What precautions should be taken in VRT for patients with migraines?

Answer 20

Start slowly, and progress exercises gradually to avoid exacerbating symptoms.

Question 21

What are contraindications for VRT?

Answer 21

Unstable vestibular disorders, uncontrolled migraines, sudden hearing loss, CSF leaks.

Question 22

What is the importance of using visual fixation during acute vestibular episodes?

Answer 22

To compensate for lost VOR by focusing on a visual target while walking.

Question 23

What is the role of assistive devices during vestibular rehabilitation?

Answer 23

They provide stability and support, helping the patient regain confidence and balance.

Question 24

How can balance exercises be progressed in vestibular rehabilitation?

Answer 24

By gradually increasing the difficulty level and incorporating more challenging tasks.

Question 25

What are some strategies to improve patient adherence to VOR exercises?

Answer 25

Use creative strategies like reading charts, balancing on challenging surfaces, and dual tasking.

Question 26

What is the significance of the Dix-Hallpike and Roll Test?

Answer 26

Tests used to diagnose Benign Paroxysmal Positional Vertigo (BPPV).

Question 27

What interventions are indicated for BPPV?

Answer 27

Canalith Repositioning Maneuvers.

Question 28

What training strategies should be used once movement is tolerated in vestibular patients?

Answer 28

Progress gaze stability, habituation, balance exercises, and overall conditioning.

Question 29

How should you start VOR exercises for a patient with severe vestibular loss?

Answer 29

Start slow and with plain backgrounds, progressing as tolerated.

Question 30

What is the role of relaxation and breathing exercises in VRT?

Answer 30

They help manage anxiety and prepare the patient for the exercises.