Vestibular Treatment Flashcards
do smooth pursuit, saccade, and slow VOR test for central or peripheral vertigo
central
does head thrust test for central or peripheral vertigo
peripheral
tests for BPPV
dix hallpike
roll test
For geotropic horizontal nystagmus, is the otoconia on the side with the weaker or stronger nystagmus?
stronger
*for apogeotropic it is on the weaker side
Your pt comes in with c/o dizziness that last for a few minutes when she changes positions. During the roll test, your pt has apogeotropic nystagmus that is stronger on the right. All other vestibular tests are negative. She has significant increased postural sway with eyes closed on firm and foam surface. In the bow test she has R beating nystagmus and in the lean test she has L beating nystagmus. What is your diagnosis?
L horizontal canal cupulolithiasis
treatments for posterior/anterior canalithiasis
- modified epley
- brandt daroff
treatments for horizontal canalithiasis
- gufoni
- BBQ roll
- forced prolonged positioning
treatments for posterior/anterior cupulolithiasis
- modified epley
- liberatory maneuver
- brandt daroff
treatment for horizontal canal cupulolithiasis
gufoni maneuver
how will you treat your pt with L horizontal cupulolithiasis? what if it was canalithaisis instead
- gufoni maneuver
- have her lay on the left side for 2 minutes, then turn her head up for 2 minutes, return to sitting
- if canalithaisis she needs to lay on R (unaffected) side
how would you treat a pt with L horizontal canalithasis
gufoni - laying on the right for 2 minutes, then turn head down for 2 minutes
what is the goal of the brandt-daroff manuever
to break the crystals off of the cupula for cupulolithiasis
forced prolonged positioning for horizontal canal canalithiasis
- pt lies on affected ear 30-60 secs
- pt rolls supine, then towards healthy ear
- pt remains in position for 12 hours during sleep
- if they have to get up at night repeat these steps
can forced prolonged positioning be used for horizontal canal cupulolithiasis
yes, just have pt lie on the affected ear all night
Your pt comes in with c/o dizzness with head movement. He describes it as lightheadedness, not spinning. He has had these symptoms for a year and was treated for vertigo with no change in symptoms. He also has L ear tinnitus. He has a positive smooth pursuit, head thrust test on the left, VOR cancellation and gaze holding, and reports dizziness with saccades. Dix-hallpike and roll test are negative. What is your diagnosis?
left unilateral hypofunction
for unilateral vestibular hypofunction, head impulse test is positive towards to ______ side
affected
positive R head impulse = R side affected
In unilateral vestibular hypofunction, right beating spontaneous nystagmus means there is __________ hypofunction
left
Direction changing nystagmus is a sign of _________ vertigo
central
What are some treatment approaches for unilateral vestibular hypofunction?
gaze stabilization
habituation
postural stabilization
VOR x1
Move head horizontally (or vertically) with focus on a specified target at arms length away
VOR x2
head and target move in opposite directions
T or F: patients should expect mild-moderate dizziness with VOR exercise
T
You want to progress to __________ BPM with VOR exercises
120
What kind of exercises can you do for habituation?
movements from the motion sensitivity quotient
