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Flashcards in Final Exam-Vestibular Lab Deck (50)
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1

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

2

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

3

HallPike-Canal tested with Head Rotation to the Right

-Right posterior
-Left anterior

4

Hallpike-Canals tested with head rotation to the L

-Left posterior
-Right anterior

5

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

6

Brandt/Daroff Canal Testing

R Post-rotate L, extend
R Ant-rotate R, flex
L Post-rotate R, extend
L Ant-rotate L, flex

7

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

8

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

9

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

10

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

11

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

12

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

13

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

14

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

15

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

16

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

17

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

18

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

19

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

20

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

21

Geotropic

nystagmus toward the ground

22

Ageotropic

nystagmus toward the sky

23

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)

24

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)

25

Right horizontal cupulolithiasis

Will See:
1. ageotropic R s preferred: rapid CRT Bar-B-Que
-modified semont maneuver: move pt into R sidelying 1st

26

Left cupulolithiasis

Will see:
1. ageotropic Ls preferred: rapid CRT Bar-B-Que
-modified semont maneuver: move pt into L sidelying 1st

27

Horizontal Canal CRT (BBQ) for canalithiasis in the R horizontal canal

-roll test position
-head turn right=hold 2 mins
-2 mins neutral
-2 mins left
-patient rolls to prone, maintain head position (don't let head extend)
-looking straight down=2 mins
-push up into quadriped with head supported by PT

28

Appiani (start with unaffected)--for R horizontal canalithiasis

-pt in short sitting
-lie on left side for 2 mins
-rotate head 45 degrees downward toward mat, hold 2 mins
-support patients head so it stays neutral

29

Phase I vestibular hypofunction treatment

-visula fixation
-EO
-stationary target
-slow head movements
-active eye and head movements between stationary targets in sitting
-static stance (EO, EC) feet together, arms out

30

review increasing difficulty of habituation exercises

on handout

31

smooth pursuit and gaze holding

-track slowly
-hold each position for a little bit to check for gaze holding nystagmus
-everyone will have nystagmus at end range (3 beats is normal, more is abnormal)

32

Saccades

-have them switch back and forth from object to your nose when you say "switch"
-overshooting or undershooting=positive test

33

VOR cancellation

-pt seated with arms out in front and you move their head while they focus on your nose (move with them)
-or pt holds arms outstretched in front
-eyes should not move off target
-big red flag if they do because it relates to the cerebellum

34

Head thrust

-grab on to sides of head, flex neck, move their head slowly and then stop quickly to one side
-positive=eyes will go to the side the head is turned and then recorrect to the middle

35

Dynamic visual acuity

-should be able to read within 2 lines of static visual acuity

36

Head shaking

-only done with fixation blocked
-head shaking is the same as the dynamic visual acuity (do this for 20 seconds), then have them open eyes, anything more than 3 beats is abnormal

37

Active eye-head movements bw 2 targets

FOR CENTRAL PROBLEMS
-sit 2-4 feet away from plain wall
-write 2 separate letters on 2 separate post-it notes
-place the letters 2 feet apart on the wall
-look at one with head and eyes, and then keeping your head on the 1st one, look at the 2nd one with only your eyes
-then turn to face the 2nd one with your eyes still focused on it
-repeat in opposite direction
-practice 1-3 mins, resting if necessary, 2-3 times per day
-can also be done with vertical targets
-vary the speed

38

Ball circles

-stand in relaxed, upright position, equal weight on both feet
-hold ball in both hands with arms out straight
-keep eyes on the ball
-turn the ball in a large circle following the balls path with your head and eyes
-repeat 15-20 times in each direction, 2-3 times daily
-if dizziness increases, stop until dizziness subsides and then begin again

39

Ankle sways

-stand with feet shoulder distance apart, equal weight on both feet, arms relaxed
-look straight ahead with eyes open
-slowly shift your weight, midline to forward (with wall/corner behind you or in front of you), midline to backward
-do not move far
-do not bend at back, hips, knees, only ankles
-then shift from side to side
-10-15 reps, 2-3 times per day
-progress by swaying diagonally

40

Brock string exercise

-tie one end of the string to a stable object (like a door knob)
-pull string taught to your nose
-focus on closest bead on the string with both eyes for 3-5 sec
-move back and forth along the string with your eyes focusing on each bead for 3-5 sec
-repeat for 1-2 mins
-progress by sliding beads closer to your nose

41

Circle sways

-stand with feet shoulder width apart
-breathe deeply and relax
-practice swaying your body in a circle (sway forward, right, rear, left)-look straight ahead and find an object to focus on
-begin with small circles, do not bend at the hips
-gradually increase how far you can move
-repeat 15-20 times in each direction, 2-3 times daily

42

general body conditioning and balance

-marching
-toe taps
-heel raises
-toe raises
-lift ups
-modified step ups
-step ups

43

Gait with head movements

-find distant target
-begin walking forward near a wall
-focus on target
-walk at normal speed
-after 3 steps, turn your head and look to the right, but continue walking straight ahead
-after 3 steps, turn to center
-after 3 steps, turn to left
-repeat 15-20 times, 2-3 times daily
-to increase difficulty try doing this while holding onto a shopping cart or on uneven surfaces

44

Saccades exercise

-sit comfotably
-hold small card with picture to focus on in each hand, level with eyes, 18 inches apart
-place cards side by side horizontally
-while keeping head still move eyes from one card to the other without stopping, repeat 15-20 times
-do the same thing vertically
-repeat diagonally
-2-3 times daily

45

Vestibular habiutation exercises

-3 times per day
-often make dizziness worse in the beginning, but it gets better
-stay in the position until dizziness subsides
-go from sitting to flat on your back (5 times)
-go from flat on back to left side (5 times)
-repeat to the right (5 times)
-sitting on the side of the bed, turn head to left and lie down quickly on the right (5 times)
-then opposite
-in sitting touch nose to left knee (5 times)
-" " right knee (5 times)
-in sitting turn head left, then right (5 times, repeat 3 times)
-right, then left " "
-move head up, then down 5 times (repeat 3 times)
-from sitting, stand up (5 times)
-from standing turn body right (5x)
-" "turn body left (5x)

46

Targets

FOR CENTRAL PROBLEMS!
-comfortable position
-find 3 targets in your room that are at eye level
-one that would be over left shoulder, on in front of you, one over right shoulder
-move head looking at left target, then center, then right
-repeat 10-15 times with out stopping
-then repeat 10-15 times stopping at each target
-2-3 times/day

47

VOR x 1

-sitting in comfortable position
-finger or small card 10 inches from nose
-focus on object while turning your head side to side
-gradually increase speed of head turns
-repeat 15-20 times
-2-3 times/day

48

VOR x 2

-same set up
-move object opposite from the side you turn your head to now

49

Visual tracking

-comfortable position
-card about 12 inches from eyes
-keep head still, move card right, center, left, center. follow card with only your eyes. 15-20x
-keeping head still, move card up, center, down, center, 15-20 times
-keeping head sstill, follow up and left, center, down and right, center, 15-20 times
-2-3 times/day

50

Head circles

-clockwise (nose circles)1 15-20 times
-repeat with eyes closed
-counter clockwise 15-20
-repeat with eyes closed
-2-3 times daily
-in sitting or standing