Vestibular Intervention

Question 1

Overall goal with vestibular intervention

Answer 1

Compensation!!

Question 2

Stimulus is the retinal slip - movement of image across retina’s fovea resulting in visual blurring
-Modifying the gain of VOR

Answer 2

Idea behind adaptation of the VOR

Question 3

VOR mediated primarily through…

Answer 3

Cerebellum and vestibular nuclei

Question 4

Influences VOR gain

Answer 4

Synaptic plasticity in purkinje fibers

Question 5

Adaptation primarily used for

Answer 5

Unilateral hypofunctioning (neuritis/labyrnthitis)

Question 6

Primary VOR intervention

Answer 6

VOR x1 VOR x2

Question 7

Target stable, head moves

Answer 7

VOR x1

Question 8

Target and head turn move opposite each other

Answer 8

VOR x2

Question 9

Good rule of thumb for increasing symptoms during exercise

Answer 9

Symptoms should not increase more than 2-3/5 and should not last longer than 15-20 minutes after completion of exercises

Question 10

Perform at least 3x per day, 12 minutes at speed of 2Hz (ideally)

Answer 10

Dosage for acute/subacute VOR x1/x2

Question 11

Perform at least 3x per day, 20 minutes, speed of 2 Hz (ideally)

Answer 11

Dosage for chronic VOR x1/x2

Question 12

VOR challenge increased/decreased when visual targets are held closer to the eyes (15 cm)

Answer 12

Increased - “convergence-mediated VOR gain enhancement”

Question 13

Performing quick impulse movements increases/decreases challenge

Answer 13

Increases ie. Sets of quick horizontal head movements with eyes fixed on target

Question 14

Cue pt to perform as many reps as possible within 30-60 seconds while keeping target mostly in focus

Answer 14

Building tolerance for increasing movement speed

Question 15

Applying and mastering alternative strategies (non-vestibular) to replace the lost or compromised VOR function

Answer 15

Substitution

Question 16

Patients with bilateral peripheral vestibular loss

Answer 16

Substitution exercises useful in patients with…

Question 17

Using smooth pursuits, saccades, and cervico-ocular reflex

Answer 17

Substituting gaze stability

Question 18

Balance exercises with varied visual and somatosensory cues

Answer 18

Substituting postural stability

Question 19

• Combines saccadic and pursuit movements
• Set up 2 targets: first move eyes only to target, then let head catch up, move eyes only to other target, let head catch up

Answer 19

Eye-head movement

Question 20

• Utilizes COR
• Focus on target, close eyes, turn head but try to keep eyes on target, open eyes and check to see if you’re still looking at the target

Answer 20

Imagined target

Question 21

Repetitive exposure to provoking movements to improve patients tolerance to those movements

Answer 21

Habituation

Question 22

• Vestibular migraine**
• Ménière’s disease
• Unilateral hypofunctioning conditions
• 3 PD**
• Post-concussive dizziness
• BPPV (sometimes)

Answer 22

Conditions habituation intervention is used for

Question 23

Motion sensitivity quotient

Answer 23

Most thorough method to identify triggers for habituation intervention

Question 24

• Prescribe exercises that produce moderate symptoms not severe (2-3/5 or 5-6/10)
  -Up to 5-10 reps, 2-3x a day

Answer 24

Dosage for habituation exercises

Question 25

An at-home treatment option for BPPV (posterior canal only) -3-5 reps each direction 2X/day & hold for 30 sec

Answer 25

Brandt-Daron exercises

Question 26

-Pen tracking, rolling ball along counter, ball toss, ball pendulum, computer-based tracking activities

Answer 26

Ideas for smooth pursuit training (think of it as central adaptations)

Question 27

-Shifting focus between 2 targets, numbered paper, reading activities, computer based activities

Answer 27

Ideas for saccade training (think of it as central adaptions)

Question 28

- Eye push-ups, near/far point fixation

Answer 28

Ideas for convergence training (think of it as central adaptation)

Question 29

-Adaptation exercises -Habituation exercises (if positionally sensitive) -Balance integration exercises -Dynamic balance activities

Answer 29

Appropriate intervention approach for neuritis

Question 30

-Substitution exercises -Balance integration exercises -Dynamic balance activities

Answer 30

Appropriate intervention approach for bilateral hypofunctioning

Question 31

-Dietary education (decrease sodium, caffeine, increase water) -Habituation exercises (if positionally sensitive) -Balance integration exercises -Refer for medical management

Answer 31

Appropriate intervention approach for Ménière’s disease

Question 32

-Dietary education (decreased aged cheese, alcohol, chocolate, MSG) -Cervical/postural treatment -Habituation exercises (if positionally sensitive) -Balance integration exercises

Answer 32

Appropriate treatment approach for vestibular migraine