Vestibular Interventions Flashcards
List intervention techniques for vestibular dysfunction
- Habitutation
- Gaze stabilization
- Balance retraining
- Endurance training
- Canalith repositioning → BPVV only
what is habituation?
the simplest form of neuroplasticity
decrease in response to a repeated benign stimuli (decrease in the amount our brain notices an unpleasant stimuli)
can be short or long-term
what is the difference between short and long term habituation?
- Short-term
- exposure to stim <30 min
- results in pre-synaptic changes
- results are generally transient
- Long-term
- exposure to stim >30 min
- results in post-synaptic changes
- more long-term effects
how does habituation relate to vestibular rehab?
in research, habituation has referred to the reduction of behavioral response to repeated exposure to a provocative stimulus, with the goal of reducing symptoms related to the vestibular system
what are gaze stabilization exercises?
exercises used to improve control of eye movements so vision remains clear during head movements
- based on assumption that they promote vestibular adaptations involving head movement while maintaining focus on target (may be stationary or moving)
- based on principles of substitution were developed with goal of promoting alternative strategies to substitute for missing vestibular function
what is the purpose of balance retraining in vestibular rehab?
- Balance training exercises are used to improve steadiness on feet, so ADLs can be performed successfully
- Intended to either strengthen vestibular input to balance integration or to facilitate use of visual and/or somatosensory cues to substitute for missing vestibular function
what are the 3 most common types of BPPV?
- Posterior Canaliathiasis
- Horizontal Canaliathiasis
- Horizontal Cupulolithiasis
Pair the examination technique with the canal
- Posterior Canal
- Dix-Hallpike Test → gold standard
- Side-lying test
- Horizontal Canal
- Roll test
- Bow and lean test
- Roll test
- Anterior Canal
- Dix-Hallpike test (contralaterally)
Prior to conducting a Dix-Hallpike what test should you perform and why?
Vertebral Artery Screen Test
the dix-hallpike will put them in a position that will compress the vertebral and basilar artery which will put the pt at risk for occluding that artery
describe how to perform the dix-hallpike
- pt in long sitting
- rotate head 45º towards the testing ear
- bring pt to supine while maintaining head rotation with either:
- head positioned off edge of plinth and extended 30-40
- head rests on depressed plinth at 30-45º ext
- pillow under back to allow for truncal and neck ext
- hold pt in position ~60 seconds while observing for nystagmus
- keep head in rotation, bring pt into long sitting
- observe eyes another 60 seconds
- allow pt to return to neutral position
- repeat on other side as appropriate
why would you perform a side-lying test over a Dix-Hallpike test?
side-lying test is an alternative to the Dix-Hallpike
useful in pts who cannot tolerate the position required for Dix-Hallpike due to neck or back problems
how do you perform the side-lying test?
- pt sitting on edge of plinth
- rotate pt’s head 45º away from the testing ear
- assist pt down onto their side in the direction ipsilateral to testing ear with head remaining rotated
- hold pt in position for 60 seconds while observing for nystagmus
- keep head in rotation, bring the pt up to sitting on the edge of the plinth
- optional:
- observe eyes for another 60 seconds before allowing pt to return to neural positioning
describe how nystagmus directional terms differ for horizontal canal
- geotropic → towards ground
- ageotropic → away from the ground
what tests are performed for dx of horizontal canalialithasis?
- ipsilateral roll test
- contralateral roll test
- Bow and Lean test
describe what occurs during the roll test
- ipsilateral roll test
- turn head to left → otoconia travel towards cupula = excitatory response
- contralateral
- turn head to right → otoconia travel away from cupula = inhibitory response
