Vestibular Treatment Flashcards
Vertical Nystagmus
Central Vestibular Dysfunction
Torsional Nystagmus
BPPV
Treatment is a Multi-Factorial Approach
- balance retraining
- oculomotor/gaze stabilization
- dynamic gait activities
- conditioning (strength, flexibility, endurance)
- walking program
- education
Make sure to tell the pt that treatment may:
-make them worse before they get better
categories of treatment
- adaptation
- substitution
- habituation
- compensation
category of treatment depends on
- unilateral vs bilateral
- complete vs partial vestibular los
Adaptation Exercises
-Gaze Stabilization exercises
if vertical problem, challenge vertical system etc
Gaze Stabilization exercise aims to_____
-improve VOR by inducing retinal slip (error signal)
CNS adjusts to get image to stick on retina
Gaze stabilization exercises involve:
-eye and head movements to improve coordination between
Gaze Stabilization Exercises particularly good in:
-treating pts with unilateral peripheral dysfunction and incomplete bilateral peripheral dysfunction
Substitution Exercises aim to improve pt’s ability to:
- use various sensory systems to improve balance control
- use central preprogramming to improve gaze stability and postural stability
Substitution exercises work by
-stressing system by reducing sensory cues–>force pt to rely on other systems/cues
(proprioception)
Habituation Exercises for patients with:
- motion sensitivity
- test people with the Motion Sensitivity Quotient to see what motions make them dizzy
Habituation Exercises
-learned suppression of vertigo through repetitive exposure to provoking movements
Habituation exercises can take up to:
-weeks to months
Compensation exercises
- use when other strategies are ineffective
- alternative strategies for function
Compensation Exercise Examples
- use AD
- hand on wall
- modify gait pattern
- extra lighting
- alter environments (rugs, clutter, color, increase contrast)
Symptoms of Unilateral Peripheral Dysfunction
- gaze instability, oscillopsia, abnormal VOR
- Vertigo caused by motion of head/body
- nystagmus
- postural instability
- sensitivity to motion in environment
- deconditioning
Use compensation for pts with:
- central vestibular problems
- bilateral problems
Goals for Unilateral Peripheral Vestibular Hypofunction
-facilitate vestibular adaptation and compensation of CNS
- improved gaze stability with head motion
- decreased sensitivity to motion
- improve static/dynamic balance
- independence with HEP
Treatment of Unilateral Peripheral Disorders
- gaze stabilization exercises (vestibular stim–X1, visuovestib stim–X2)
- balance retraining
- conditioning
- edu
Progressing Gaze Stabilization Exercises
-X1 & X2
- distracting background
- varying distance from patient
- increased speed
- increased duration
- more compliant floor surfaces and altered foot positions (narrowed)
X1
X2
“times 1” and “times 2”
Sx Bilateral Peripheral Vestibular Dysfunction
- gaze instability, oscillopsia
- negative head shaking test if B vestibular function is complete loss
- postural instability (esp if vision/proprioception reduced)
- gait abnormalities: wide BOS
- insensitivity to motion in environment
- deconditioning
Treatment of Bilateral Peripheral Disorders
-facilitate substitution to increase reliance on vision/proprioception
Goals of bilateral peripheral disorders
- improve gaze stab
- improve static/dynamic balance
- I with HEP
- I with modification of ADL/IADLs
Unilateral Peripheral Recovery Length
6-8 weeks
Bilateral Peripheral Recovery Length
up to 2 years
may be incomplete or get worse with medical problems
Treatment of Bilateral Peripheral Disorders
- oculomotor exercises (head/eye movement, 2 targets, imaginary targets etc)
- balance
- conditioning
- education
Central Disorders Symptoms
-vary
Central Disorders Goals
- fall prevention/safety
- compensatory strategies to improve gaze stability
- static/dynamic balance
- I with HEP
- indep modification of ADL/IADLs
Treatment of Central Disorders
- oculomotor ex’s
- habituation ex’s
- balance retraining
- dynamic gait
- conditioning
- AD, home safety
- anxiety/coping strategies
- education
Treatment for Motion Sensitivity
-select up to 4 movements
-perform quickly to provoke symptoms
-rest after each until Sx stop
-3-5 sets of each
2-3x/day
-CNS can adapt and become less sensitive to these movements
Treatment of BPPV: Post & Ant SCC
- Canalith Repositioning Maneuver (CRM)
- Brandt-Daroff Habituation Exercises (self management)
- Liberatory (Semont) Maneuver (fast/violent movement, not well tolerated
CRM
- canalith repositoning maneuver
- Epley Maneuver
- passively moved through series of positions
- post-maneuver precautions
Instructions for After CRM
- possibly suggest pt sleep reclined for 1 night
- pt may feel ‘off’ for 1-2 days
- hand outs to self-manage recurrence
- follow-up PT session
