Non-BPPV Interventions

Question 1

what is a medical emergency if this happens during eval or treatment?

Answer 1

sudden hearing loss

Question 2

which non-BPPV diagnosis types have worse prognosis?

Answer 2

chronic
bilateral

Question 3

which diagnosis is most responsive to treatment?

Answer 3

BPPV

Question 4

which VOR disturbance usually resolves in a few days by itself?

Answer 4

static

Question 5

which VOR disturbance is due to abnormality in VOR gain and abnormal input to vestibular nuclei?

Answer 5

dynamic

Question 6

if vestibular symptoms don’t resolve spontaneously within ____, then the CNS is unable to modify/adapt on its own

Answer 6

4-7 days

Question 7

adaptations require ____ signal to initiate neuroplastic adaptations

Answer 7

error

Question 8

normal VOR gain

Answer 8

1

Question 9

abnormal VOR gain

Answer 9

retinal slip
blurry images during head movement
oscillopsia

Question 10

when do you know a treatment is too much?

Answer 10

image becomes blurry

Question 11

during treatment, pt will experience sx but must attempt to continue exercises for _____ without stopping as long as ____

Answer 11

1 minute
target remains in focus (no blurry)

Question 12

immediate effects of habituation

Answer 12

reduced sensitivity of Ca+ channels and release of NT

Question 13

long-term effects of habituation

Answer 13

change in size and number of synapses

Question 14

how is unilateral vs bilateral vestib hypofunction treated?

Answer 14

uni - adaptation
bi - substitution

Question 15

what are the 4 exercise components to unilateral vestib hypofunction?

Answer 15

gaze stability (adaptation)
habituate
postural stability
endurance

Question 16

what are the 4 exercise components to bilateral vestib hypofunction?

Answer 16

adaptation of remaining function
substitution***
postural stability
aerobic fitness
modifications to home and work

Question 17

T/F: saccades and smooth pursuits can be done in isolation for hypofunction treatment.

Answer 17

F!!

Question 18

red flags for vestib treatment

Answer 18

sudden hearing loss or fluctuation in hearing
increased pressure &/or fullness to point of discomfort
discharge of fluid from ear(s)
severe ringing in ear(s)

Question 19

treat BPPV FIRST, then if symptoms still persist after ____ incorporate VOR

Answer 19

1-2 weeks

Question 20

what are the VOR exercises for adaptation?

Answer 20

VOR x1
VOR x2
VORc

Question 21

exercise rx for VOR adaptation exercises

Answer 21

1-2 min intervals
minimum of 3x per day
12 min = acute
20 min = chronic
sx provocation for 5-10 min post

Question 22

what is VORx1?

Answer 22

focus on station target (14-pt x) at eye level for 1 minute with horizontal and vertical head movements at 2 Hz

Question 23

what is VORx2?

Answer 23

head and target move opposite while eyes fixate on target
goal: 2 minutes at pt’s fastest speed

Question 24

what is VORc?

Answer 24

eyes and head move in same direction as target
goal: 50 bpm for 2 mins

Question 25

how far should the head be rotating during VOR exercises?

Answer 25

60 deg

Question 26

what are the VOR substitution exercises?

Answer 26

active eye movements b/w 2 targets remembered/imagined target

Question 27

purpose of active eye movements b/w 2 targets

Answer 27

oculomotor substitute (saccade and smooth pursuit)

Question 28

Rx for VOR substitution exercises

Answer 28

1 min at a time 3x per day throughout day

Question 29

purpose of imagined target

Answer 29

cervical substitute for vestibular input

Question 30

difference between VORc test and treatment

Answer 30

test - passive treat - active

Question 31

what is VORc?

Answer 31

pt actively move head and eyes in same direction as target

Question 32

which exercises are indicated for all vestibular pt?

Answer 32

grounding/surface reorientation esp. for non-BPPV

Question 33

grounding/surface reorientation exercises

Answer 33

diaphragmatic breathing box breathing

Question 34

habituation exercises are indicated for

Answer 34

motion sensitivity central vestib dysfunction mixed vestib dysfunction

Question 35

T/F habituation is a last resort

Answer 35

T

Question 36

what maneuver is commonly done for habituation?

Answer 36

Brandt-Daroff

Question 37

Rx for habituation

Answer 37

4 positions that provoke sx 2-3 reps of moving through them fast 2x/day for 8 weeks

Question 38

for habituation, it may take up to ___ for sx to decrease

Answer 38

4 weeks