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Vestibular Rehabilitation Flashcards

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1
Q

what is the idea behind vestibular rehabilitation

A

symptom and impairment driven rehabilitation based upon exercise to assist with compensation

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2
Q

those with _______ are appropriate patients for vestibular rehabilitation

A

head/visual motion that provokes symptoms

balance, gait, or gaze stability impairments

stable central or peripheral lesion

no specific ages

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3
Q

those with _______ are inappropriate patients for vestibular rehabilitation

A

episodic or spontaneous fluctuating symptoms

no provocative activity or balance dysfunction

progressive central lesions

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4
Q

in those with acute UVH, what is important to remember regarding timing of rehab

A

Early VRT (<2wks of onset): increased VOR gain and adaptation

Late VRT:
increased compensatory saccades and substitution

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5
Q

for those with Chronic UVH or Bilateral VH, what does timing implementation of VRT affect

A

there is no effect of time of VRT implementation from time of onset on efficacy of VRT

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6
Q

compare median of recovery time in those with chronic UVH vs BVH

A

U = 4 months
B = 12 months

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7
Q

in those with chronic UVH/BVH, what did VRT improve

A

symptom severity
balance confidence
gait speed
DGI score
DVA

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8
Q

what are the mechanisms of recovery in VRT

A

adaptation of reflexes
substitution
habituation

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9
Q

what is the thought behind adaptation VRT / what is the expected outcome

A

long term change in neuronal response of the vestibular system to head movement

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10
Q

what is hoped to be produced during adaptive VRT

A

error signal (retinal slip)
- while moving the head to induce change in the VOR

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11
Q

what is the overarching goal of adaptation exercises

A

gaze stability
postural stability
reduction of symptoms

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12
Q

what is retinal slip

A

the difference between actual movements of the eyes and desired movement needed to keep image stable

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13
Q

what is substitution defined as in VRT

A

use of alternative strategies to replace lost or compromised function

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14
Q

if the VSR is compromised, what is substituted in place

A

other sensory systems like vision or somatosensory

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15
Q

if the VOR is compromised, what is substituted in place

A

COR = cervical ocular reflex

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16
Q

what is the COR

A

pre-programmed eye movements elicited by mechanoreceptors at cervical joints

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17
Q

what is the definition of habituation in VRT

A

long-term reduction of a response to noxious stimulus through repeated exposure to provocative stimulus

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18
Q

what factors can modify rehabilitation outcomes

A

anxiety
depression
peripheral neuropathy
migraine
abnormal binocular vision
abnormal cognition

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19
Q

what medications can affect rehabilitation outcomes

A

long term use of vestibular suppressants (meclizine)

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20
Q

what has been proven to help modify symptoms without affecting rehabilitation outcomes in those with chronic vestibular disorders

A

low dose antihistamines

or

zofran

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21
Q

what are the components of VRT

A

gaze stabilization exercises
habituation exercises
balance/gait activities
general conditioning

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22
Q

what does the CPG peripheral vestibular disorders recommend?

what can it improve?

A

VRT
- postural/gaze stability
- decrease subjective complaints
- improve QOL

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23
Q

for peripheral UVH, what is the treatment option

A

gaze stabilization exercises
habituation

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24
Q

for BVH what is the treatment option

A

gaze stabilization exercise

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25
for motion sensitivity, what is the treatment option
habituation
26
for central vestibular dysfunction, what is treatment option
habituation
27
for BPPV, what is the treatment option
canalith repositioning manuevers
28
what is vestibular rehabilitation treatment determined by
symptoms impairments activity limitation participation restrictions
29
gaze stabilization exercises are designed to ____ and are performed by _____
increase gain of the neuronal response of vestibular system continuously moving head in horizontal and vertical directions
30
what are the variations of gaze stabilization exercises for adaptation
VOR x1 - only head moving VOR x2 - object and head moving in opposite directions
31
what would indicate therapist to modify gaze stabilization exercises for adaptation
- if object gets blurry - retinal slip occurs - saccadic intrusion all indicate to slow head speed
32
what are the variations of gaze stabilization based upon substitution
eye-head movement between target remembered target
33
explain eye-head movement exercise protocol
eyes and head facing on 1st target eyes shift to 2nd target (lateral or vertical) while head is still head then turns to face 2nd target
34
protocol of remembered target exercises
eyes focused on a target -- close eyes head turns while eyes remain on the target open eyes and check for accuracy
35
what are eye-head movements between target exercises beneficial for
BVH in order to reduce oscillopsia with head movements
36
dosage of gaze stabilization exercises for those with acute/subacute UVH
3x a day ≥12 min daily
37
dosage of gaze stabilization exercises for those with chronic UVH
3-5x a day > 20 min daily 4-6 weeks
38
dosage of gaze stabilization exercises for those with chronic BVH
3-5x a day 20-40 min 5-7 wks
39
when educating patient on gaze-stabilization exercises, what is important to explain
there will be an increase in symptoms and that is supposed to happen!! empowering patient to recognize increase symptoms and to pace themselves based upon this --> should not last more than 20-30 min
40
what are the variables most important to progress during gaze stabilizing exercises for those with hypofunction
duration and speed
41
what are the variables that can be manipulated in gaze stabilization exercises
duration speed background complexity position distance target size dose
42
what is the goal for duration to extend to
2 minutes - begin with 1 to start
43
related to speed, what is the goal during gaze stabilization exercises
retinal slip while maintaining focus and moving head as quickly as possible
44
what can be used to cue patient on speed during gaze stabilization exercises
letter almost going out of focus, but not to keep symptoms minimal and to return to baseline before next repetition
45
what can be used as an external cue during gaze stabilization exercises? any specifics?
metronome range of 40-144bpm about 96 bpm initially with goal of 240bpm
46
what is the head speed necessary for VOR activation
>120° per second at 2 Hz - around 120 bpm
47
regarding a position / balance change, what are the options for manipulation
seated/standing static vs dynamic altered base of support altered support surface walking variations
48
what are the walking variations that can be implemented in gaze stabilization exercises
overground / treadmill forward, backward / sideways
49
how can vision be manipulated in ways other than just closing the eyes
having patient move the head have patient look at a dynamic object
50
regarding distance variable of gaze-stabilization exercises, what are our options
near the target (arm length) far (6-10 feet) walking toward and away size of target
51
letter size in regard to distance of target
close = 14 pt far = 54 pt
52
indications of postural control interventions
self-report of disequilibrium with head motion/walking instability with head motion while walking high risk for falls / history of falls restricted activity
53
balance and gait exercises are based upon principles of
substitution
54
goals of postural control exercise
minimize symptoms w/head motion normal use of sensory inputs for balance reduce falls / fall risk return to normal activities
55
optimal balance exercise dosages for those with chronic UVH
minimum of 20 min daily ≥ 4-6 wks
56
optimal balance exercise dosages for those with chronic BVH
daily exercise for ≥ 6-9 wks
57
what are the balance training principles
consider static and dynamic balance challenge pt but allow success observe posture consider other systems that may be affected during consider goals and what PLOF looked like
58
when challenging patients during balance training, what can be added
concurrent tasks - manual or cognitive head movements
59
when implementing balance interventions, it is important to remember to
maintain safety allow for early success for confidence HEP within tolerance
60
guideline of HEP within balance intervention
only 3-5 different balance exercises maximization of challenge with minimization of risks
61
what indicates motion provoked dizziness
dizziness of vertigo with position changes / dizziness with busy visual background
62
interventions for motion provoked dizziness are based upon
habituation principles
63
goal of motion provoked dizziness rehabilitation
minimization of symptoms with positional changes
64
what is important to determine when considering motion provoked dizziness
if symptoms are due to - positional or movement changes or - visually provoking environments
65
what measures are used in motion provoked dizziness if determined cause is positional changes
motion sensitivity tests modified MST
66
what measure is used in motion provoked dizziness if determined visually provoked
visual vertigo analog scale
67
treatment considerations for motion provoked dizziness related to - environment - exercises - reps - frequency - intensity
moderately stimulating environments ≤ 4 movements 3-5 reps per motion 2-3x a day fast enough to produce mild-moderate amount of dizziness
68
when to eliminate exercises in HEP related to motion provoked dizziness
can be performed for 2 days without symptoms
69
when to check BP during treatment
if symptoms are brought on by moving from heart low to heart high positions
70
when is it time to discharge a patient from VRT
achievement of primary goals resolution of symptoms normalized balance/vestibular function plateau in progress
71
average POC associated with - chronic UVH - chronic BVH
U = 4-6 weeks, once a week, HEP B = 6-9 weeks, once a week, HEP, maintainance of activity

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