Vestibular Intervention Flashcards
What is the goal of vestibular interventions?
Compensation! Pt may or may not fully recover but interventions can reduce symptoms and frequency of episodes
Treatment theories for compensation
- Approximate/promote normal gaze stability (adaptation)
- Utilize alternative eye movements to make up for VOR deficits (substitution)
- Reduce symptoms through the use of repeated posture changes/head movements (habituation)
Adaptation of the VOR
- Stimulus is the retinal slip
- VOR mediated through cerebellum and vestibular nuclei. Synaptic plasticity in purkinje cells influences VOR gain (change how cerebellum influences eye mvmt)
Adaptation Indications
- Unilateral hypofunction (neuritis/labyrinthitis)
- Not bilateral issues unless there is still some vestibular function or if one side is worse.
Primary adaptation intervention
- VOR x 1 (VOR test)
- VOR x 2 (target and head turn opposite of one another)
Adaptation dosage
Acute: at least 3x/day, 12 minutes
Chronic: at least 3x/day, 20 minutes
New Approaches to VOR Adaptation
- Challenge target distance
- Vary head mvmt speed (can do impulse mvmts)
- Build tolerance for increasing mvmt speed
Substitution
- Applying and mastering alternative/non-vestibular strategies to replace compromised VOR
- Substituting gaze stability - SP, saccades, cervicoocular reflex
- Substituting postural stability - balance w varied visual and somatosensory cues
Substitution Indications
- Bilateral peripheral vestibular loss
Substitution Exercises
- Eye head movement - combines saccadic and SP
— 2 targets, move eyes to one then let head catch up. Move eyes to other, let head catch up. - Imagined target - utilizes COR
— focus on target, close eyes and turn head but try to keep gaze on target, then open eyes
CRITICAL to vary velocity, amplitude, posture
Habituation
- Repetitive exposure to provoking movements to improve pt tolerance to those movements
- Exact underlying mechanisms is unknown, but habituation to sensory input is a normal response in healthy individuals
Habituation Indications
- Vestibular migraine
- Ménière’s disease
- UL hypofunctioning (neuritis)
- Central dizziness (3PD, post concussion)
- BPPV *sometimes
Habituation interventions
- Evaluate w motion sensitivity quotient (MSQ)
- Should produce moderate symptoms not severe
- Perform 2-3x/day up to 5-10x
- Ex: supine head turns, bend over in sitting, standing head turns, bending in standing w head turn
Progression of treatments
- Time/repetition
- BOS/hand support/visual focusing cues
- Changing surfaces
- Distance and range of target/positions
- Background distortion
- Optokinetics
Brandt-Daroff Exercises
- Perform 2x/day, 3-5 reps
- Turn head R, lie L until dizziness goes away +30s, sit up quick and wait 30s, turn head L, lie R until dizziness goes away +30s, sit up quick and wait 30s.
Oculomotor Treatments
“Central adaptation”
- Smooth pursuits: pen tracking, rolling ball on counter, ball toss, pendulum
- Saccades: shift focus bw 2 targets, reading activities, numbered paper
- Convergence: eye push-ups, near/far pt fixation
Neuritis Tx
- Adaptation exercise
- Habituation exercise
- Balance integration exercise
- Dynamic balance activities
BL hypofunction Tx
- Substitution exercise
- Balance integration exercise
- Dynamic balance activities
Meniere’s Disease Tx
- Dietary education
- Habituation exercises if positional sensitivity
- Balance integration exercise
- Refer for medical management
Vestibular Migraine Tx
- Dietary education (dec aged cheese, alc, MSG, chocolate)
- Cervical/postural tx
- Habituation exercises if positional sensitivity
- Balance integration exercise
