Vestibular Part 3 Flashcards
What are symptoms of central vestibular dysfunction?
- Ataxia can be severe
- Abnormal smooth pursuits & saccades, diplopia
- Hearing loss would be sudden & permanent if AICA stroke
- Vertigo is mild
- Pendular or vertical nystagmus at equal rates
What are symptoms of peripheral vestibular dysfunction?
- Mild to no ataxia
- Normal smooth pursuits & saccades
- Tinnitus, fullness in ears
- Acute vertigo that is intense
- Slow & fast phase nystagmus
What is Canalith Repositioning Maneuver used for a diagnosis of?
BPPV
What specific CRM is used for Posterior Canal BPPV Canalithiasis?
Epley Maneuver
What specific CRM is used for Cupulolithiasis?
Liberatory Sermont
What specific CRM is used for Horizontal Canalithiasis?
BBQ Roll
What specific CRM is used for Horizontal cupulothiasis?
Gufoni Maneuver
What are adaption exercises?
Designed to promote gaze stability, induce long term changes in the neuronal response to head movements, & reduce symptoms
Adaption or Gaze Stabilization Exercises are used for primary and secondary treatment of what?
- Primary: Unilateral Vestibular Hypofunction
- Secondary: Bilateral Vestibular Hypofunction
What is the goal of Adaptation or Gaze Stabilization Exercises?
Improve neuronal firing rate (rebalance) of the vestibular system & reduce retinal slip
How is adaption or gaze stabilization exercises achieved and what do they result in?
- Achieved: Head movements while maintaining focus on a target
- Results: Reduced symptoms, normalized gaze stability during head movements & normalized postural stability
How is VOR x 1 Exercises performed?
- Patient looks at a point in front of them (their thumb, X on the wall)
- Start at distance of arms length
- Moves their head back & forth as fast as possible but slow down to keep target in focus
- Patient does as many reps as possible, working up to 1 minute or until their symptoms increase too much
How are VOR x 2 exercises performed?
- Patient looks at a point in front of them (their thumb, x on index card)
- As they move the point back & forth, they move their head & eyes in opposite direction but slow down to keep target in focus
- Patient does as many reps as possible working up to 1 minute
Describe how you can progress VOR Exercises?
- Progress by changing position (sit, stand, Romberg, tandem, SLS, walking forward/ back)
- Progress by changing distance away (1m-3m)
- Progress by changing background
- Progress to performing VOR x 2
How long will unilaterally hypofunction need adaptation exercises? And what is the HEP? How does the HEP dosage change for chronic vs acute/ subacute?
- Weekly supervised clinic visits 4-6 weeks
- HEP: Gaze stabilization exercises & progression
- HEP (acute): 3x per day for at least 12 minutes
- HEP (Chronic): 3-5x per day for at least 20 min (total)
How long will Bilateral hypofunction need adaptation exercises? And what is the HEP?
- Weekly supervised clinic visits 5-7 weeks
- HEP: Gaze stabilization exercises & progression
- HEP Dosage: 3-5x per day for a total of 20-40 minutes daily
When using adaptation exercises how long until symptoms should resolve?
15 minutes from completion of exercise
T/F: Balance Training and walking programs are other interventions for UVH
True
- Static & dynamic balance exercises for 20 min daily for 4-6 weeks
What diagnosis is substitution exercises used for the primary and secondary treatment of?
- Primary: Bilateral Vestibular Hypofunction
- Central Vestibular Disorders
T/F: Saccadic or smooth pursuit eye movement are recommended for treating UVH
False- No, b/c do not have ocular issues
What is the goal of substitution exercises?
- Promote alternative strategies to substitute for impaired or lost vestibular function to improve postural & gait stability
- Increase reliance on visual cues
- Increase reliance on somatosensory cues
- Increase reliance on cervical ocular reflex
What is the dosage for substitution exercises?
3-5x/day for 20-40 minutes
How is active eye head movement performed?
- Hold 2 target at arm’s length from your head. Look with your eyes for to one of the target (X) & make sure your nose is pointed to the “X” as well.
- Now look at the “Y” with your eyes only, followed by turning your head horizontally to point your nose to the “Y”
- Repeat this sequence
- Attempt to perform for 60 seconds
What type of exercise is Active Eye Head Movement and what does it treat?
- Substitution
- Treat BVH
