Final Exam-Vestibular Lab Flashcards
VBI Testing
- pt can be in sitting
- rotate their head to the side and then extend slightly
- hold for 10 seconds and asses for dizziness, blakcout, drop attack
- return head to neutral and hold for at least 10 sec
- repeat on opposite side
- can also do this in supine
- if pt is coming to you for dizziness and you do this in supine you can get a false positive
- can also have patient put arms in the air and close eyes and watch for an arm to drop
- talk to the pt
- symptoms will increase if it’s VBI
- symptoms will be bad at the beginning and decrease if it’s BPPV
Hallpike-Dix Test Procedure–right side testing
- Tests for BPPV
- patient in long sitting so that when you lay them back their head, neck, and part of shoulders will be off the table
- hold both sides of patients head (near their ears, unless hearing aide)
- remind pt to keep eyes open
- turn patients head 45 degrees to the right
- quickly lay them in supine and extend neck 30 degrees
- hold this position and observe for nystagmus
- sit the patient back up and repeat for the other side
HallPike-Canal tested with Head Rotation to the Right
- Right posterior
- Left anterior
Hallpike-Canals tested with head rotation to the L
- Left posterior
- Right anterior
Brandt/Daroff Side lying Test–procedure
- for BPPV
- Position patient in short sitting at edge of plinth with enough room that when they side lie the head/neck will be supported
- rotate patients 45 degrees and extend 30 degrees
- sidelie them on the OPPOSITE shoulder
- hold for 2 mins and observe for nystagmus
- return to short sitting and observe for reverse nystagmus
- then test other side
Brandt/Daroff Canal Testing
R Post-rotate L, extend
R Ant-rotate R, flex
L Post-rotate R, extend
L Ant-rotate L, flex
Right posterior canlithiasis
-hall pike dix test (head rotated R)
-or brandt/daroff (head rotated L, extend 30)
Will see:
1. transient nystagmus
2. upbeat and R torsion
Treat:
-CRT beginning R HPD position (if nystagmus switches, debris is going wrong direction, start over)
-brandt/daroff exercises bilateral
Left posterior canilithiasis
-hall pike dix test (head rotated to the L)
-or brandt/daroff (head rotated R, extend 30)
Will See:
1. transient nystagmus
2. upbeat and L torsion
Treat:
-CRT beginning L HPD position (if nystagmus switches, debris is going wrong direction, start over)
-brandt/daroff exercises bilateral
Right posterior cupulolithiasis
-hall pike dix (head rotated R)
-or brandt/daroff (head rotated L, extend 30)
Will See:
1. Persistent nystagmus
2. Upbeat and R torsion
Treat:
-liberatory maneuver R sidelying, head L with 1 min hold, PT hand on forehead
-brandt/daroff exercises 10-15x 3-5x/day until 2 days without vertigo
Left posterior cupulolithiasis
-hall pike dix (head rotated L)
-or brandt/daroff (head rotated R, extend 30)
Will See:
1. Persistent nystagmus
2. upbeat and L torsion
Treat:
-liberatory maneuver R sidelying, head R with 1 min hold, PT hand on forehead
-brandt/daroff exercises 10-15x 3-5x/day until 2 days without vertigo
Right Anterior Canalithiasis
-hall pike dix (head rotated L)
-brandt/daroff (head rotated R, flex 30 degrees)
Will See:
1. transient nystagmus
2. downbeat and R torsion
Treat:
-neck ext particle repositioning maneuver (esp when side of involvement is unknown)
-FWD roll particle repositioning maneuver with head L
-CRT beginning R HPD position
-Brandt/daroff exercises bilaterally
Left anterior canalithiasis
-hall pike dix (head turned R)
-brandt/daroff (head turned L, flex 30 degrees)
Will See;
1. transient nystagmus
2. downbeat and L torsion
Treat:
-neck ext particle repositioning maneuver (if side of involvement is unknown)
-FWD roll particle repositioning with head R
-CRT beginning L HPD position
-Brandt/daroff exercises, treat bilaterally
Right anterior cupulolithiasis
-hall pike dix (head rotated L)
-brandt/daroff (head rotated R, flex 30 degrees)
Will See:
1. persistent nystagmus
2. downbeat and R torsion
Treat:
-liberatory maneuver R Sidelying, head R with 1 min holds, PT hand on occiput
-brandt daroff exercises 10-15x 3-5x/day until 2 days w/o vertigo
L anterior cupulolithiasis
-hall pike dix (head turned R)
-brandt/daroff (head turned L, flex 30 degrees)
Will See:
1. persistent nystagmus
2. downbeat and L torsion
Treat:
-liberatory maneuver L Sidelying, head L with 1 min holds, PT hand on occiput
-brandt daroff exercises 10-15x 3-5x/day until 2 days w/o vertigo
CRT
- canalith repositioning treatment
- used to treat canalithiasis BPPV in ant or post semicircular canals
- if it’s a right sided problem, you turn their head R
CRT procedure (for R side)
- hall pike dix positioning is 1st treatment position (if you get a positive during this test, go immediately into this without checking the other side, check the other side next visit)
- patient in supine with head, neck and part of shoulders off plinth
- head rotated R and extended=2 mins
- turn head rotated L and extended (DO NOT LET PATIENT LIFT HEAD, NEED TO STAY IN EXT OR START OVER)=2 mins
- pt turns into L sidelying, head stays rotated, once positioned in sidelying head will be looking towards ground=2 mins
- then sit them up maintaining rotation and slight flexion
- wait at least 15 mins before repeating if it doesn’t work, recommended 30 min-1hr
Brandt/Daroff CRT
- rotate patients head based on the canal to be treated
- always lay them down on the affected side (no matter which way the head is turned)
- hold for 2 mins
- return pt to short sitting
- hold for 2 mins
- rotate patients head to the opposite side and into opposite sidelying
- hold for 2 mins
- return to 90/90
- repeat 10-20x 3-5x/day until vertigo is absent for 2 consecutive days
Semont Liberatory Maneuver for Cupulolithiasis-procedure for R post cupulolithiaisis
- pt in sitting at edge of plinth
- turn head L and PT places hand on forehead
- lay them into R sidelying quickly, maintaining the head position
- hold 2 mins
- 1 hand behind head and 1 hand on forehead
- throw patient all the way into L sidelying, protecting forehead from hitting mat
- stay in this posiiton for 2 mins
Semont Liberatory for R anterior cupulolothiathisis
-same as for R post, but this time you are rotating the head right and going down on toward the effective side
Roll test for horizontal canal
- clear C/S
- position patient in supine
- flex head 20 degrees
- rotate patients head to the right=hold 2 mins
- rotate patients head to neutral=hold 2 mins
- rotate patients head to the left=hold 2 mins
Geotropic
nystagmus toward the ground
Ageotropic
nystagmus toward the sky
Right horizontal canalithiasis
Will see; 1. postive roll test 2. geotropic R>L Treat: -CRT supine R with roll to L maintaining neck in 20 degrees flexion -appiani maneuver (begin in L sidelying)
Left horizontal canalithiasis
Will see: 1. positive roll test 2. geotropic L>R Treat: -CRT supine (L) with roll to (R) maintaining neck in 20 degrees flexion -Appiani maneuver (begin in R sidelying)
