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NMR II > Vestibular Part 3 > Flashcards

Vestibular Part 3 Flashcards

1
Q

What are symptoms of central vestibular dysfunction?

A
  • Ataxia can be severe
  • Abnormal smooth pursuits & saccades, diplopia
  • Hearing loss would be sudden & permanent if AICA stroke
  • Vertigo is mild
  • Pendular or vertical nystagmus at equal rates
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2
Q

What are symptoms of peripheral vestibular dysfunction?

A
  • Mild to no ataxia
  • Normal smooth pursuits & saccades
  • Tinnitus, fullness in ears
  • Acute vertigo that is intense
  • Slow & fast phase nystagmus
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3
Q

What is Canalith Repositioning Maneuver used for a diagnosis of?

A

BPPV

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4
Q

What specific CRM is used for Posterior Canal BPPV Canalithiasis?

A

Epley Maneuver

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5
Q

What specific CRM is used for Cupulolithiasis?

A

Liberatory Sermont

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6
Q

What specific CRM is used for Horizontal Canalithiasis?

A

BBQ Roll

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7
Q

What specific CRM is used for Horizontal cupulothiasis?

A

Gufoni Maneuver

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8
Q

What are adaption exercises?

A

Designed to promote gaze stability, induce long term changes in the neuronal response to head movements, & reduce symptoms

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9
Q

Adaption or Gaze Stabilization Exercises are used for primary and secondary treatment of what?

A
  • Primary: Unilateral Vestibular Hypofunction
  • Secondary: Bilateral Vestibular Hypofunction
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10
Q

What is the goal of Adaptation or Gaze Stabilization Exercises?

A

Improve neuronal firing rate (rebalance) of the vestibular system & reduce retinal slip

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11
Q

How is adaption or gaze stabilization exercises achieved and what do they result in?

A
  • Achieved: Head movements while maintaining focus on a target
  • Results: Reduced symptoms, normalized gaze stability during head movements & normalized postural stability
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12
Q

How is VOR x 1 Exercises performed?

A
  • Patient looks at a point in front of them (their thumb, X on the wall)
  • Start at distance of arms length
  • Moves their head back & forth as fast as possible but slow down to keep target in focus
  • Patient does as many reps as possible, working up to 1 minute or until their symptoms increase too much
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13
Q

How are VOR x 2 exercises performed?

A
  • Patient looks at a point in front of them (their thumb, x on index card)
  • As they move the point back & forth, they move their head & eyes in opposite direction but slow down to keep target in focus
  • Patient does as many reps as possible working up to 1 minute
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14
Q

Describe how you can progress VOR Exercises?

A
  • Progress by changing position (sit, stand, Romberg, tandem, SLS, walking forward/ back)
  • Progress by changing distance away (1m-3m)
  • Progress by changing background
  • Progress to performing VOR x 2
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15
Q

How long will unilaterally hypofunction need adaptation exercises? And what is the HEP? How does the HEP dosage change for chronic vs acute/ subacute?

A
  • Weekly supervised clinic visits 4-6 weeks
  • HEP: Gaze stabilization exercises & progression
  • HEP (acute): 3x per day for at least 12 minutes
  • HEP (Chronic): 3-5x per day for at least 20 min (total)
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16
Q

How long will Bilateral hypofunction need adaptation exercises? And what is the HEP?

A
  • Weekly supervised clinic visits 5-7 weeks
  • HEP: Gaze stabilization exercises & progression
  • HEP Dosage: 3-5x per day for a total of 20-40 minutes daily
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17
Q

When using adaptation exercises how long until symptoms should resolve?

A

15 minutes from completion of exercise

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18
Q

T/F: Balance Training and walking programs are other interventions for UVH

A

True
- Static & dynamic balance exercises for 20 min daily for 4-6 weeks

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19
Q

What diagnosis is substitution exercises used for the primary and secondary treatment of?

A
  • Primary: Bilateral Vestibular Hypofunction
  • Central Vestibular Disorders
20
Q

T/F: Saccadic or smooth pursuit eye movement are recommended for treating UVH

A

False- No, b/c do not have ocular issues

21
Q

What is the goal of substitution exercises?

A
  • Promote alternative strategies to substitute for impaired or lost vestibular function to improve postural & gait stability
  • Increase reliance on visual cues
  • Increase reliance on somatosensory cues
  • Increase reliance on cervical ocular reflex
22
Q

What is the dosage for substitution exercises?

A

3-5x/day for 20-40 minutes

23
Q

How is active eye head movement performed?

A
  • Hold 2 target at arm’s length from your head. Look with your eyes for to one of the target (X) & make sure your nose is pointed to the “X” as well.
  • Now look at the “Y” with your eyes only, followed by turning your head horizontally to point your nose to the “Y”
  • Repeat this sequence
  • Attempt to perform for 60 seconds
24
Q

What type of exercise is Active Eye Head Movement and what does it treat?

A
  • Substitution
  • Treat BVH
25
Q

What type of exercise is Imaginary Target and what does it treat?

A
  • Substitution
  • Treat BVH
26
Q

How is Imaginary Targets performed?

A
  • Hold one target at arm’s length
  • Close your eyes & turn your head horizontally away from target, attempting to keep your eyes focused on target
  • Open your eyes after turning your head
  • Goal: Eyes remain on target
27
Q

What is the progression of substitution exercises?

A
  • Sitting
  • Standing
  • Change/Decrease BOS
  • Use a busy background
28
Q

Name some other substitution ideas beside imaginary targets & active head movements?

A
  • Use of night lights in home
  • Use of an AD
  • Ensuring proper footwear
  • Improving balance (ankle, hip & stepping strategies)
29
Q

T/F: Vestibular Adaptation Exercises can be used to treat BVH

A

True, many patients have an asymmetrical BVH
- VORx2 will likely be too aggressive causing excessive retinal slip

30
Q

T/F: Daily walking program, pool & Tai Chi are not good to perform when a patient has BVH.

A

False but some activities may be limited such as walking or driving in the dark, sports involving quick head movements

31
Q

Habituation is the primary treat for what diagnosis?

A

Central Vestibular Dysfunction

32
Q

What are habituation exercises?

A
  • Exercises or movements that systematically expose the individual to a provocative stimulus that over time with repeated exposure leads to a reduction in symptoms
  • Could be a movement based or situation based (busy environment)
  • Balancing act of inducing symptoms (brain learns) & overwhelming the system
33
Q

How are habituation exercises performed?

A
  • Performs several reps of body or visual motions that cause mild to moderate symptoms
  • Assume provoking position & wait 10 sec for symptoms to appear
  • If dizziness occurs, remain in the position for an additional 20 sec (30 total) or until dizziness stops
  • Return to starting position & wait 10 sec (or until symptoms subside)
  • Repeat 5x
34
Q

What is the HEP for habituation exercises?

A
  • Perform 3-5x each & complete 2-3x/day
  • Keep diary to track progress
35
Q

When performing habituation exercises how long does it take for symptoms to improve?

A

Symptoms normally decrease within 2 weeks

36
Q

What SOM can be used to guide habituation exercises?

A

Motion Sensitivity Quotient

37
Q

Give some examples of habituation exercises

A
  • Quickly move from sitting upright to bending at the trunk as if to touch your nose to you knee
  • Quickly move from sitting at edge of the bed to lying flat
  • Roll left & right
  • Turning head left to right (VOR)
38
Q

What should you do if a patient has a flare up with habituation?

A
  • Use grounding techniques
  • Sitting in stable chair: feet on floor, armrest, back against chair
  • Staring at stationary object
  • Controlled breathing
  • Cold washcloth or peppermint oil
39
Q

T/F: Both optokinetic stimulation and virtual reality are other habituation treatments.

A
  • True
  • Optokinetic Stimulation: Use of repetitive moving patterns provided by optokinetic discs, moving rooms, busy screen savers on computers, or video of busy visual environments
  • Virtual Realty: Immerses patient in realistic, visually challenging environments
40
Q

Ocular Muscle strengthening can be used for what disorder?

A

Central Dysfunction
- Pencil Push Up
- Brockstring
- Visual Tracking & Saccades

41
Q

What is the dosage of balance & gait training for:
- UVH:
- BVH:
- Central Vestibular Dysfunction:

A
  • UVH: 4-6 weeks
  • BVH: 6-9 weeks
  • Central Vestibular Dysfunction: 6 months & beyond
42
Q

Balance and gait training is good for everyone what should the prescription include and for how long?

A
  • Prescribe 20 minutes daily
  • Include: steady, anticipatory & reactive
  • Steady: eyes open; eyes closed compliant surface
  • Anticipatory (w/ head turns): walking & turning, walking with head turns, dual task
43
Q

What is the average rehab time for UVH?

A

6-8 wks (acute may require less if VR is started early, wishing 2 wks

44
Q

What is the average rehab time for BVH?

A

Up to 2 years for full recovery

45
Q

What is the average rehab time for BPPV?

A

1 - 2 treatments

46
Q

What is the average rehab time for central?

A

6 month or more & may be incomplete

NMR II (14 decks)

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