Vestibular Intervention Flashcards
Overall goal with vestibular intervention
Compensation!!
Stimulus is the retinal slip - movement of image across retina’s fovea resulting in visual blurring
-Modifying the gain of VOR
Idea behind adaptation of the VOR
VOR mediated primarily through…
Cerebellum and vestibular nuclei
Influences VOR gain
Synaptic plasticity in purkinje fibers
Adaptation primarily used for
Unilateral hypofunctioning (neuritis/labyrnthitis)
Primary VOR intervention
VOR x1 VOR x2
Target stable, head moves
VOR x1
Target and head turn move opposite each other
VOR x2
Good rule of thumb for increasing symptoms during exercise
Symptoms should not increase more than 2-3/5 and should not last longer than 15-20 minutes after completion of exercises
Perform at least 3x per day, 12 minutes at speed of 2Hz (ideally)
Dosage for acute/subacute VOR x1/x2
Perform at least 3x per day, 20 minutes, speed of 2 Hz (ideally)
Dosage for chronic VOR x1/x2
VOR challenge increased/decreased when visual targets are held closer to the eyes (15 cm)
Increased - “convergence-mediated VOR gain enhancement”
Performing quick impulse movements increases/decreases challenge
Increases ie. Sets of quick horizontal head movements with eyes fixed on target
Cue pt to perform as many reps as possible within 30-60 seconds while keeping target mostly in focus
Building tolerance for increasing movement speed
Applying and mastering alternative strategies (non-vestibular) to replace the lost or compromised VOR function
Substitution
Patients with bilateral peripheral vestibular loss
Substitution exercises useful in patients with…
Using smooth pursuits, saccades, and cervico-ocular reflex
Substituting gaze stability
Balance exercises with varied visual and somatosensory cues
Substituting postural stability
- Combines saccadic and pursuit movements
- Set up 2 targets: first move eyes only to target, then let head catch up, move eyes only to other target, let head catch up
Eye-head movement
- Utilizes COR
- Focus on target, close eyes, turn head but try to keep eyes on target, open eyes and check to see if you’re still looking at the target
Imagined target
Repetitive exposure to provoking movements to improve patients tolerance to those movements
Habituation
- Vestibular migraine**
- Ménière’s disease
- Unilateral hypofunctioning conditions
- 3 PD**
- Post-concussive dizziness
- BPPV (sometimes)
Conditions habituation intervention is used for
Motion sensitivity quotient
Most thorough method to identify triggers for habituation intervention
- Prescribe exercises that produce moderate symptoms not severe (2-3/5 or 5-6/10)
-Up to 5-10 reps, 2-3x a day
Dosage for habituation exercises
An at-home treatment option for BPPV (posterior canal only)
-3-5 reps each direction 2X/day & hold for 30 sec
Brandt-Daron exercises
-Pen tracking, rolling ball along counter, ball toss, ball pendulum, computer-based tracking activities
Ideas for smooth pursuit training (think of it as central adaptations)
-Shifting focus between 2 targets, numbered paper, reading activities, computer based activities
Ideas for saccade training (think of it as central adaptions)
- Eye push-ups, near/far point fixation
Ideas for convergence training (think of it as central adaptation)
-Adaptation exercises
-Habituation exercises (if positionally sensitive)
-Balance integration exercises
-Dynamic balance activities
Appropriate intervention approach for neuritis
-Substitution exercises
-Balance integration exercises
-Dynamic balance activities
Appropriate intervention approach for bilateral hypofunctioning
-Dietary education (decrease sodium, caffeine, increase water)
-Habituation exercises (if positionally sensitive)
-Balance integration exercises
-Refer for medical management
Appropriate intervention approach for Ménière’s disease
-Dietary education (decreased aged cheese, alcohol, chocolate, MSG)
-Cervical/postural treatment
-Habituation exercises (if positionally sensitive)
-Balance integration exercises
Appropriate treatment approach for vestibular migraine
