Vestibular Rehab Flashcards
how do pts frequently limit daily activities when having vestibular issues
- become disabled/unemployed
- decreased social activities
- marriages are impacted
- etc
when should vestibular rehab begin?
- as soon after the vestibular insult as possible
- while this sounds easy, it often takes a while to convince pts to get started
- after a traumatic experience, they are very concerned that any movement will worsen their situation
three problems pts with vestibular problems might be facing
- fatigue as the day goes by (they will be worn out)
- anxiety is often a difficulty that needs to be addressed
- the autonomic nervous system reactions really kick in (fight or flight) so they might have hyperventilation and increased blood pressure
how will a patient with vestibular problems be moving
- often walk like a robot or like a metal rod is preventing them from moving properly
- careful when changing positions
- –sit to stand
- –laying to sitting
- –turning around
- –turning while walking
why dont some patients want to be treated
- fear/anxiety
- fatigue
- hyperventilation
- increased blood pressure (from stress)
- ***the very reasons pts dont want to have rehab is why they should
audiologists role in vestibular rehab
- referral
- epiley
- counseling
- —most dont treat because we cant bill for it (but are able to directly treat BPPV)
what is the most common canal involved in BPPV and what is the nystagmus like
posterior canal is the most common site of lesion and it is rotary up beating towards the side of the lesion
nystagmus with posterior canal BPPV
rotary up beating with torsion to the side involved
nystagmus with horizontal BPPV
horizontal
nystagmus with anterior BPPV
rotary down beating towards the side involved
treatment options for BPPV
- wait and see if it can clear up on its own
* canalith repositioning maneuvers which have roughly a 80-95% cure rate after 1-2 maneuvers
semont maneuver (BPPV)
- pt is rapidly moved from lying on one side to lying on the other
- a brisk maneuver that is not currently favored in the US, but it is 90% effective after 4 treatment sessions
Brandt-Daroff Exercises (BPPV)
- known as habituation exercises not a repositioning treatment
- 98% of pts improve after 3-14 days of the exercises
- pts often get frustrated that they are not immediately improved
- however, this is preferential for some because they do not like the restrictions recommended after the Epely or travel restrictions do not allow multiple epley trips (after epley are supposed to limit movement for 48 hours)
how to do the Brandt-Daroff Exercises
- lay on one side and look up at the ceiling until not dizzy then count to 30, then sit up until not dizzy then wait 30 seconds, then lay to other side until dizziness ends plus 30 seconds and sit up again.
- do three sets of 5 daily
the epley maneuver (BPPV)
- sequential movement of the head into four positions, staying in each position roughly 30 seconds
- –recurrence rate for BPPV after these maneuvers is about 30% at one year, and in some instances a second treatment may be necessary
- –also referred to a CRM (canal repositioning maneuver)
