lab 4: periperhal vestibualr hypofunction (PVH) treatments

Question 1

what are the 3 mechanisms of vestibular recovery

Answer 1

adaptation , substitution , and habituation

Question 2

what is a recovering mechanism for VOR allows
system to make long-term changes in how it responds to input by utilizing remaining capabilities; involves combination of head movement & visual input to modify VOR gain; requires “error signal” to initiate neuroplastic adaptations

Answer 2

adaptation

Question 3

If a patient is using a adaptation intervention they will experience symptoms but must attempts what

Answer 3

continues exercises for 1 full minute without stopping as long as the target remains in focus

Question 4

If visual target becomes blurred during an adaptation exercises then ___
velocity of head movements, then
progress to full velocity (2Hz) under
varying task/environment demands and
increase duration to 1 min, then, 2 min.

Answer 4

decreased

Question 5

what is Increasing utilization of other strategies to replace lost vestibular function; useful after bilateral VOR loss or with central dysfunction
or combination of peripheral & central dysfunction

Answer 5

subsitution

Question 6

when is substitution used

Answer 6

after bilateral VOR loss or with central dysfucntion or combination of peripheral and central dysfucntion

Question 7

what is Repeated exposure to a stimulus decreases brain’s pathological response to
that stimulus; brain gets used to it

Answer 7

habituation

Question 8

for vestibular rehabilitation for peripheral unilateral hypofunction (NON BPV) exercises based w combination of what 4 exercise components

Answer 8

• exercises to promote gaze stability (adaptation)
• exercises to habituate symptoms of vertigo
• postural stability
• endrucnae

Question 9

what are the treatment approached for peripheral bilateral hypofunction (non BPV)

Answer 9

• increasing function of nay remaining vestibular system via adaptation exerceis
• inducing alternative mechanisms to maintain gaze stability via substitution exercises
• improve postural stability durin head movement
• progressive aerobic fitness
  -modifications of home

Question 10

t/f: Clinicians should NOT offer
saccadic or smooth pursuit
exercises in isolation (without
head movement) as a specific
exercise for gaze stability to pts
with unilateral or bilateral
PVD/H/L

Answer 10

true

Question 11

what exercises do you use for unilateral non BPV PVH

Answer 11

adaptation

Question 12

what exercises do you use for bilateral non BPV PVH

Answer 12

substitution

Question 13

what oculomotor exercises address CNS function but not vestibular ? and why does it not address vestibular

Answer 13

saccades, smooth pursuit , convergence , ocular ROM

bc there is no head movement

Question 14

what are adaptation exercises for PVH/L

Answer 14

VOR

gaze stabilization

eye head coordination

Question 15

when would u use adaptation exercises

Answer 15

for unilateral peripheral vestibular hypofunction

Question 16

how many times should patients perform adaptation exercises

Answer 16

every day 3 x a day w intensity that makes pt dizzy but not sick

Question 17

when should the speed of head movement be increased during adapatation exercises

Answer 17

as long as the target stays in focus and does not blur

Question 18

how do u do VOR x1 as an adapatation exercises for unilateral hypofunction

Answer 18

head movement at 2Hz in horizontal or vertical planes from 1 min at a time while maintains focus on no a stationary target at eye level (if they can’t do 2Hz start at whatever they can tolerate)

Question 19

what do u do if the pt is unable to perform VOR x1 as a adaptation exercise

Answer 19

start w ocular exercises alone from 1 min , 3x a day until able to do VOR

Question 20

how should u start VOR x1

Answer 20

quiet environment , solid neutral background, pt sitting/standing on firm surface w wide BOS

Question 21

how do u progress to VOR X2 for adaptation exercise

Answer 21

being able to do VOR 1 for 2 mins at a time

Question 22

how to progress to VORc for adaptation exercises

Answer 22

progress to performing actively at 50bpm for 2 mins at a time

Question 23

what must u explain as part of HEP for adaptation to occur

Answer 23

need to complete 1-2 mins intervals of VOR exercises a minimum of 3x per day

Question 24

how long do u do VOR adaptation exercises for acute and chronic peripheral UVH

Answer 24

acute is 12 mins total
chronic is 20 mins

Question 25

what is the 5 (to 10 min) rule

Answer 25

symptoms provocation which last 5-10 mins after stopping exercise is desirable

Question 26

what are some progression variables for VOR exercises for adapatation

Answer 26

- speed -duration -amplitude -target distance -target size - VORx1 then VORx2 - multi task (add balance , cognitive task) -direction (horizontal and vertical but can progress to diagnosable and angled positions

Question 27

what would indicate you to use VOR substitution #1

Answer 27

severe bilateral peripheral vestibular loss

Question 28

if there is any residual function what exercises (interventions) will u give the pt

Answer 28

adaptation exercises (VOR x1) and substitution exercise

Question 29

what is VOR substitution #1

Answer 29

active eye head movement between 2 targets

Question 30

how do u do VOR substitution #1 (active eye head movements between 2 targets)

Answer 30

goal is to keep target focuses u have 2 targets on a wall and u have patient look at one target and the turn their head towards that target and then look at the other target and move their head towards that target repeat for 1 min at a time and do at least 3x per day

Question 31

what is the VOR exercises substitution #2

Answer 31

remembered or imagined target (stationary target)

Question 32

how do u instruct the pt for VOR substitution #2 (remembered or imagined target)

Answer 32

tell pt to look and focus on a target at nose level , then tell them to close their eyes and turn head away from target while maintains eyes on the remember target tell pt to open eyes and see if their eyes remembered the imagined target asses accuracy and repeat for 1 min at a time so at least 3x a day

Question 33

how do u progress Remembered or Imagined Target (Stationary Target)

Answer 33

more reps at 1 min at a time alone w varying other parameters

Question 34

when would u used VORc exercise

Answer 34

chronic UVH pt

Question 35

what is VORc managed by

Answer 35

by the vestibulocerebellum by inhibiting the VOR gain during VORc.

Question 36

what is an abnormal response to VORc

Answer 36

pt makes repetitive refixations (jerk nystagmus) during the middle of each rotation pass

Question 37

how do u perfomr the VORc exercise

Answer 37

have pt actively move their eyes and head int he same direction as a moving object that they are tracking between their thumbs work up to 1 min at a time , do 3x per day to retain VORc start slow then progress to fast speed

Question 38

what is the 5(to 10 min) rule for VORc exercise

Answer 38

symptoms provocation which last 5-10 min after stopping exercise is desirable

Question 39

how can u progress VORc exercise

Answer 39

- direction - postural support (seated > standing) - background complexity (blank wall > busy wall) - speed - amplitude - duration

Question 40

what is the indication for habituation ? (not on practical)

Answer 40

for pt w motion sensitivity or central vestibular dysfucntion or mixed vestibular dysfunction

Question 41

what is the goal of habituation

Answer 41

decreased stimulus response through repeated exposure to stimulus

Question 42

what is a classic example of a habituation exercise

Answer 42

brandt-daroff

Question 43

what is the most important intervention

Answer 43

patient education

Question 44

what are the interventions for unilateral peripheral vestibular hypofunction that we are gonna do on the practical

Answer 44

1. oculomotor exercises (only if eye movement alone provokes symptoms) 2. VOR x1 3. VOR x2 4/ VORc in this sequence (adaptation exercises )

Question 45

what are the interventions for bilateral peripheral vestibular hypofunction/loss (non BPPV) that we will do on the practical

Answer 45

1. oculomotor exercises (only if eye movement alone provided symptoms) 2. VOR x1 ( if residual function remaining) and active eye head movements between 2 targets PLUS remembered (imagined) targets 3. VORc

Question 46

what do u do if. a pateints has central vestibular dysfunction and eye movmeemtns alone cause dizziness in pts with known CNS (not on practical)

Answer 46

oculomotor exercises (ocular ROM , vengeance , smooth pursuit, saccades , VORc) habituation exercises gait and balance progressive aerobic fitness program