Vestibular Rehab Flashcards
peripheral pathologies
- labyrinth related
- BPPV
- vestibular neuritis
- labyrinthitis
- acoustic neuroma
Central vestibular pathologies
- brain related
-CVA
-MS
-Cerebellar disorder
anatomy of labyrinth
-semicircular canals:
- vertical: anterior and posterior canals
- lateral: horizontal canal
-otolith organs: saccule, utricle
BPPV
causes
pathomechanism
-benign, paroxismal (comes and goes) positional vertigo
- head spins when change positions
- causes: head trauma, infection, vestibular weakness, advancing age
- otoconia is displaced from the macula of utricle
canalithiasis vs cupulothiasis
- canalithiasis: <1min. stuck in canal
- cupulothiasis: persists in duration >1 min, stuck in cupula
BPPV signs and sxs
Vertigo:
- when bending or getting up
- when changing positions in bed
- change in head position
Nystagmus:
- nonvoluntary, repetitive and rapid eye movements
- most important symptom!
Dix Hallpike test
(A) The patient’s head is turned (45 degrees)
toward her affected ear while she is in a sitting
position.
(B) The patient is quickly moved into a supine
position with her head extended (20-30 degrees
off the table) and rotated 45 degrees toward her
ear.
Posterior Canal - Upbeating torsional Nystagmus
Anterior Canal - Downbeating torsional Nystagmus
Epley maneuver aka Canalith Repositioning Maneuver
A series of four head positions – Maintain each position for 1 to 2 minutes or until the vertigo and nystagmus has
stopped to ensure otoconia low through the canal.
1. (A and B) 45° to the more symptomatic side and 30° below horizontal (the Dix-Hallpike exam position)
2. (C) Rotate 45° to the other side keeping 30° declination
3. (D) Roll to sidelying (uninvolved side), nose down
4. (E) Slowly sit up, maintaining head position flexed (chin tucked) and rotated
Slowly return the head to upright and remain sitting 3-4 minutes, then repeat until no symptoms are seen
Semont or Liberatory maneuver for cupulothiasis
Turn head to opposite side!
The head is
rotated 45° to the left side. (B) With assistance, the patient is then moved from
sitting to right side-lying and stays in this position for 1 minute. (C) The patient is
then rapidly moved 180°, from right side-lying to left side-lying. The head should
be in the original starting position, left rotated (nose down in final position) in
this example. Note that the otoconia have been dislodged from the cupula.
After 1 minute in this position, (D) the patient returns to sitting.
Brandt Daroff Exercise
- generic exercise: for HEP or if pt cant tolerate CRM
- Start sitting up. Turn head to 1 side (doesnt matter which)
- Side lye on oppostie side
- Sit up, turn head other direction, side lye on contra side
Supine roll test
- For horizontal canal
- Supine with head in 20deg cervical flexion
- Turn head to one side
- Look for nystagmus and sxs
- Geotrophic beating: canalithiasis
side of more intense sxs is affected - Ageotrophic beating: cupulothiasis
side with less intense sxs is affectd
BBQ roll/canalith repositioning maneuver for Horizontal canal
- for horizontal canalithiasis and cupulothiasis
-Head in 20deg flexion during test - Begin in supine
- turn head 90deg to affected side
- back to neutral
- turn head 90deg to contralat side
- Roll into prone
What assessments to do for vestibular function
Cranial nerve and coordination
Eye assessments: smooth persuits, saccades, VOR (head impulse test)
- need to refer if central lesion is present
smooth persuits
- follow finger with eyes
- CN3, central
saccades
-CN3, central
- overshoot/undershoot is abnormal
