Vestibular Practical Flashcards
Three types of vestibular dysfunctions
imbalance (postural), vertigo/dizziness, oscillopsia/blurred vision
postural imablance is a ____ tract problem
vestibulospinal
caused by impaired ability to resolve sensory conflicts/head positions
vertigo/dizziness
caused by dysfunction of VOR control
blurred vision
Best impairment level measure for VOR testing
Head thrust test
helps determine most provocative movements while also acting as an intervention
motion sensitivity quotient
postural imbalance outcome measures for vestibular dysfunction
rhomberg, SR, SLS
CTSIB
Berg Balance Scale (not impairment lvl)
pt. is unable to stabilize vision during head movement
VOR impairment
pt. is unable to distinguish self movement from environmental/visual movement
dizziness/vertigo
pt. is unable to maintain balance, posture, and gravity orientation
disequilibrium (VST)
“I lose my balance and fall a lot”
VST balance dysfuntion
“I have blurred vision or bouncing vision”
VOR problem
“The room is spinning”
vertigo
“I feel dizzy or drunk”
sensory conflict
How would you differentiate between vertigo and sensory mismatch
vertigo is positional change-use Motion Sensitivity Score
Sensory mismatch can be from dizziness with visual conflict- use VMS (pt holds thumb in front of them while facing a busy part of the clinic, they move as a unit, and tries to keep focus on their thumb. Ask about dizziness VAS)
Error signal for balance
falling, increased sway
error signal for sensory conflict
dizziness
error signal for VOR
double-vision or blurring
Interventions for balance
establish ability to use hip, ankle and stepping strategies in the correct context
Interventions for Dizziness
use visual and/or somatosensory cues to re-educate vestibular system and then gradual withdraw those cues. Treat in 1st position which provokes symptoms
interventions for VOR
improve visual blurring-fixate on thumb maintaining clear image during head motion at 2 Hz or above and progress to image on the wall.
Gaze stabilization - walking with fixation, progress to head turns in walking with fixation and perhaps slow run
General principles of vestibular rehab
change environment to require adaptability.
treatment begins at the level that symptoms occur.
exercises must provoke the symptoms.
2-3 weeks to improve on the exercise program
Vestibular Rehab exercises
do about 4 exercises max 3-5x/day.
Provide an exercise for each of the symptoms (imbalance, blurred vision, dizziness)
