Vestibular Treatments Interventions

Question 1

What are the goals of BPPV treatment?

Answer 1

Return otoconia to vestibule where they belong
Reduce vertigo associated with head motion
Improve Balance
Independence in ADLs and return to prior level of function

Question 2

What is the Epley Maneuver used for?

Answer 2

Posterior Canalithiasis

Question 3

Describe the Epley Maneuver

Answer 3

-Patient head is rotated 45 toward the involved side
-Then the patient is moved to Dix-Hallpike position
-Next head is rotated 90 degrees to uneffected side with 30 neck extension
-Patient is rolled onto unaffected ears shoulder
Then sit patient up

Question 4

What is used to treat horizontal Canalythiasis?

Answer 4

BBQ Roll

Question 5

Describe the BBQ roll for right sided horizontal canal BPPV

Answer 5

Head Flexed 20 degrees

• Patient’s head initally placed 90 degrees to right (affected side)
• Wait till nystagmus stops + 30 seconds
• Turn head straight up (wait + 30 seconds)
• Turn head 90 degrees to left (wait + 30)
• Then roll to prone

Question 6

How successful are canalith repositioning methods?

Answer 6

85% success on first attempt

2% pf patients require 3 or more repositioning treatments

Question 7

What are some education topics post-maneuver to give to a patient?

Answer 7

Movement of the head is ok and should be performed to avoid stiff neck

Question 8

What is the Liberatory (Semont) maneuver

Answer 8

Rapid movement to dislodge debris of cupula
Used for Posterior SCC cupulothiasis
Can be used as alternate treatment for canalith repositioning

Question 9

Describe the Liberatory (Semont) maneuver

Answer 9

• Turn head to uneffected ear
• Lay on side with affected ear facing down (head turned up)
• Quickly move to other side with head facing down (don’t turn head)
• Sit back up

Question 10

What is the Brandt-Daroff Exercises?

Answer 10

Acts to dislodge debris from cupula or cause debris to move out of canal
(originally designed to habituate the CNS to provoking positions)

Question 11

How often do you perform the Brandt-Daroff Exercise?

Answer 11

5-10 repetitions 3 times per day

Continue until no vertigo for 2 consecutive days

Question 12

Describe how the Brandt-Daroff Exercises are performed.

Answer 12

• Start in sitting position then turn head 45 degrees (either way)
• Lay down on side (head is facing up)
• Wait till vertigo stops +30 seconds
• return to sitting position, then rotate head other way
• Go to other shoulder (head should still be facing up)

Question 13

What is used for BPPV due to canalithiasis?

Answer 13

Canal repositioning (Eply's, BBQ Roll)
-Posterior canal more common

Question 14

What is used for BPPV cupulothiasis?

Answer 14

Liberatory (Semont) Maneuver

Question 15

What do you use if there is persistent/residual or mild vertigo (even after repositioning methods)

Answer 15

Brandt-Daroff Exercises

Question 16

What is the order for treatments of UVH?

Answer 16

Gaze stability exercises
Postural Stability Exercises
Habituation Exercises (motion sensitivity)

Question 17

What are the goals of UVH treatment?

Answer 17

Improve stability of gaze during head movements
Diminish sensitivity to motion
Improved static and dynamic postural stability
Independence in proper performance of HEP

Question 18

What are gaze stability exercises designed to do?

Answer 18

Improve VOR and other systems

Expose patients to retinal slip

Question 19

What are the 2 Gaze stability exercises?

Answer 19

X1 = Target stable, head moves
X2 = Both target and head moves
Can move horizontal or vertical

Question 20

How can you progress gaze stability exercises?

Answer 20

Distract background
Vary distance
Move head faster
Perform exercises in different positions (standing vs sitting)

Question 21

When do you use habituation exercises?

Answer 21

When patient with UVH has CONTINUAL complaints of dizziness

Not all patients should be treated with habituation

Question 22

How often do you perform habituation exercises?

Answer 22

3-5 times, 2-3 times a day

Question 23

What are the goals for BVH treatment?

Answer 23

Improve stability of gaze during head movement
Reduced subjective complaints of gaze instability
Improve Static and dynamic balance
Independent HEP
Enhance decision making skills regarding performance of basic and instrumental ADLs

Question 24

What are some treatment methods for BVH?

Answer 24

X1 exercises (X2 should only be used if asymmetrical)
Exercises that incorporate sequenced eye and head movements
Use imaginary targets
Daily walking is important and should start right away

Question 25

What is the primary components patients with BVH use for postural stability?

Answer 25

Somatosensation and/or vision

Question 26

Do habituation exercises work for BVH?

Answer 26

Don’t even try it

Question 27

How long is recovery for BVH?

Answer 27

Can take up to 2 years

Question 28

What are the goals for abnormal central vestibular function treatment?

Answer 28

Enhance decision making for fall prevention and safety
Compensatory strategies for gaze stability
Independent HEP includes walking

Question 29

What is the general time it will take someone with abnormal central vestibular funciton?

Answer 29

6 months or more

Question 30

What are the treatment methods for Abnormal Central Vestibular Function Treatment?

Answer 30

Similar to UVH treatment if lesion is at level of brainstem
Start with habituation exercises
Gait and balance exercises designed to incorporate somatosensory, visual, and vestibular contributions