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Neuromuscular Conditions II > Vestibular Treatment > Flashcards

Vestibular Treatment Flashcards

1
Q

Vertical Nystagmus

A

Central Vestibular Dysfunction

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2
Q

Torsional Nystagmus

A

BPPV

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3
Q

Treatment is a Multi-Factorial Approach

A
  • balance retraining
  • oculomotor/gaze stabilization
  • dynamic gait activities
  • conditioning (strength, flexibility, endurance)
  • walking program
  • education
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4
Q

Make sure to tell the pt that treatment may:

A

-make them worse before they get better

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5
Q

categories of treatment

A
  • adaptation
  • substitution
  • habituation
  • compensation
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6
Q

category of treatment depends on

A
  • unilateral vs bilateral

- complete vs partial vestibular los

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7
Q

Adaptation Exercises

A

-Gaze Stabilization exercises

if vertical problem, challenge vertical system etc

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8
Q

Gaze Stabilization exercise aims to_____

A

-improve VOR by inducing retinal slip (error signal)

CNS adjusts to get image to stick on retina

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9
Q

Gaze stabilization exercises involve:

A

-eye and head movements to improve coordination between

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10
Q

Gaze Stabilization Exercises particularly good in:

A

-treating pts with unilateral peripheral dysfunction and incomplete bilateral peripheral dysfunction

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11
Q

Substitution Exercises aim to improve pt’s ability to:

A
  • use various sensory systems to improve balance control

- use central preprogramming to improve gaze stability and postural stability

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12
Q

Substitution exercises work by

A

-stressing system by reducing sensory cues–>force pt to rely on other systems/cues

(proprioception)

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13
Q

Habituation Exercises for patients with:

A
  • motion sensitivity

- test people with the Motion Sensitivity Quotient to see what motions make them dizzy

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14
Q

Habituation Exercises

A

-learned suppression of vertigo through repetitive exposure to provoking movements

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15
Q

Habituation exercises can take up to:

A

-weeks to months

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16
Q

Compensation exercises

A
  • use when other strategies are ineffective

- alternative strategies for function

17
Q

Compensation Exercise Examples

A
  • use AD
  • hand on wall
  • modify gait pattern
  • extra lighting
  • alter environments (rugs, clutter, color, increase contrast)
18
Q

Symptoms of Unilateral Peripheral Dysfunction

A
  • gaze instability, oscillopsia, abnormal VOR
  • Vertigo caused by motion of head/body
  • nystagmus
  • postural instability
  • sensitivity to motion in environment
  • deconditioning
19
Q

Use compensation for pts with:

A
  • central vestibular problems

- bilateral problems

20
Q

Goals for Unilateral Peripheral Vestibular Hypofunction

A

-facilitate vestibular adaptation and compensation of CNS

  • improved gaze stability with head motion
  • decreased sensitivity to motion
  • improve static/dynamic balance
  • independence with HEP
21
Q

Treatment of Unilateral Peripheral Disorders

A
  • gaze stabilization exercises (vestibular stim–X1, visuovestib stim–X2)
  • balance retraining
  • conditioning
  • edu
22
Q

Progressing Gaze Stabilization Exercises

A

-X1 & X2

  • distracting background
  • varying distance from patient
  • increased speed
  • increased duration
  • more compliant floor surfaces and altered foot positions (narrowed)
23
Q

X1

X2

A

“times 1” and “times 2”

24
Q

Sx Bilateral Peripheral Vestibular Dysfunction

A
  • gaze instability, oscillopsia
  • negative head shaking test if B vestibular function is complete loss
  • postural instability (esp if vision/proprioception reduced)
  • gait abnormalities: wide BOS
  • insensitivity to motion in environment
  • deconditioning
25
Q

Treatment of Bilateral Peripheral Disorders

A

-facilitate substitution to increase reliance on vision/proprioception

26
Q

Goals of bilateral peripheral disorders

A
  • improve gaze stab
  • improve static/dynamic balance
  • I with HEP
  • I with modification of ADL/IADLs
27
Q

Unilateral Peripheral Recovery Length

A

6-8 weeks

28
Q

Bilateral Peripheral Recovery Length

A

up to 2 years

may be incomplete or get worse with medical problems

29
Q

Treatment of Bilateral Peripheral Disorders

A
  • oculomotor exercises (head/eye movement, 2 targets, imaginary targets etc)
  • balance
  • conditioning
  • education
30
Q

Central Disorders Symptoms

A

-vary

31
Q

Central Disorders Goals

A
  • fall prevention/safety
  • compensatory strategies to improve gaze stability
  • static/dynamic balance
  • I with HEP
  • indep modification of ADL/IADLs
32
Q

Treatment of Central Disorders

A
  • oculomotor ex’s
  • habituation ex’s
  • balance retraining
  • dynamic gait
  • conditioning
  • AD, home safety
  • anxiety/coping strategies
  • education
33
Q

Treatment for Motion Sensitivity

A

-select up to 4 movements
-perform quickly to provoke symptoms
-rest after each until Sx stop
-3-5 sets of each
2-3x/day

-CNS can adapt and become less sensitive to these movements

34
Q

Treatment of BPPV: Post & Ant SCC

A
  • Canalith Repositioning Maneuver (CRM)
  • Brandt-Daroff Habituation Exercises (self management)
  • Liberatory (Semont) Maneuver (fast/violent movement, not well tolerated
35
Q

CRM

A
  • canalith repositoning maneuver
  • Epley Maneuver
  • passively moved through series of positions
  • post-maneuver precautions
36
Q

Instructions for After CRM

A
  • possibly suggest pt sleep reclined for 1 night
  • pt may feel ‘off’ for 1-2 days
  • hand outs to self-manage recurrence
  • follow-up PT session

Neuromuscular Conditions II (15 decks)

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