Vestibular Treatments Interventions Flashcards
What are the goals of BPPV treatment?
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
What is the Epley Maneuver used for?
Posterior Canalithiasis
Describe the Epley Maneuver
-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
What is used to treat horizontal Canalythiasis?
BBQ Roll
Describe the BBQ roll for right sided horizontal canal BPPV
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
How successful are canalith repositioning methods?
85% success on first attempt
2% pf patients require 3 or more repositioning treatments
What are some education topics post-maneuver to give to a patient?
Movement of the head is ok and should be performed to avoid stiff neck
What is the Liberatory (Semont) maneuver
Rapid movement to dislodge debris of cupula
Used for Posterior SCC cupulothiasis
Can be used as alternate treatment for canalith repositioning
Describe the Liberatory (Semont) maneuver
- 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
What is the Brandt-Daroff Exercises?
Acts to dislodge debris from cupula or cause debris to move out of canal
(originally designed to habituate the CNS to provoking positions)
How often do you perform the Brandt-Daroff Exercise?
5-10 repetitions 3 times per day
Continue until no vertigo for 2 consecutive days
Describe how the Brandt-Daroff Exercises are performed.
- 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)
What is used for BPPV due to canalithiasis?
Canal repositioning (Eply's, BBQ Roll) -Posterior canal more common
What is used for BPPV cupulothiasis?
Liberatory (Semont) Maneuver
What do you use if there is persistent/residual or mild vertigo (even after repositioning methods)
Brandt-Daroff Exercises
What is the order for treatments of UVH?
Gaze stability exercises
Postural Stability Exercises
Habituation Exercises (motion sensitivity)
What are the goals of UVH treatment?
Improve stability of gaze during head movements
Diminish sensitivity to motion
Improved static and dynamic postural stability
Independence in proper performance of HEP
What are gaze stability exercises designed to do?
Improve VOR and other systems
Expose patients to retinal slip
What are the 2 Gaze stability exercises?
X1 = Target stable, head moves
X2 = Both target and head moves
Can move horizontal or vertical
How can you progress gaze stability exercises?
Distract background
Vary distance
Move head faster
Perform exercises in different positions (standing vs sitting)
When do you use habituation exercises?
When patient with UVH has CONTINUAL complaints of dizziness
Not all patients should be treated with habituation
How often do you perform habituation exercises?
3-5 times, 2-3 times a day
What are the goals for BVH treatment?
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
What are some treatment methods for BVH?
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
What is the primary components patients with BVH use for postural stability?
Somatosensation and/or vision
Do habituation exercises work for BVH?
Don’t even try it
How long is recovery for BVH?
Can take up to 2 years
What are the goals for abnormal central vestibular function treatment?
Enhance decision making for fall prevention and safety
Compensatory strategies for gaze stability
Independent HEP includes walking
What is the general time it will take someone with abnormal central vestibular funciton?
6 months or more
What are the treatment methods for Abnormal Central Vestibular Function Treatment?
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
