Vestibular Rehabilitation
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| show | Somatosensory
Vision
Vestibular
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| show | fluid moves as you move your head, cilia detect the movement of the fluid and send signals to the brain about the movement
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| where are otoconia stones located? | show 🗑
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| show | abnormal eye movements due to interruption in the VOR
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| how is nystagmus named? | show 🗑
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| show | yes based on the position
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| show | torsional nystagmus, eyes twist
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| show | brain injury or bleed, more acute injuries will have a faster nystagmus
things may still look normal to the pt because the brain is overriding the response
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| when can CNS dampen nystagmus? | show 🗑
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| what in a pts history might make you think vestibular? | show 🗑
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| show | vertigo is the feeling of spinning and related to vestibular system
dizziness can occur before passing out (orthostatic), can also be a symptom of other pathology (stroke, MI, low blood sugar), can be from meds too
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| most vestibular issues are ____ | show 🗑
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| show | Initial Onset
Duration of symptoms
Position when symptoms occur
Description of symptoms
Circumstances
What provokes symptoms?
Sick prior?
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| vestibular neuritis | show 🗑
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| show | peripheral, central
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| oculomotor exam | show 🗑
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| show | Vertical nystagmus
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| show | Have pt sit forward with head in hands, elbows on knees.
Turn head to one side
Provide cognitive task for pt such as counting backwards from 30 by 3s
Watch for nystagmus, change in concentration/cognition, dizziness or visual changes
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| red flags that warrant more questions | show 🗑
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| why is vertebral artery testing important? | show 🗑
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| show | exam designed to rule in/out posterior circulation strokes before they would show up on CT (sometimes takes up to 24 hrs to get on imaging) designed for use in ER
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| what does HINTS stand for? | show 🗑
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| head impulse test | show 🗑
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| show | peripheral. central
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| show | central
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| show | The most common form of vertigo and balance disorders
60% of all peripheral vestibular disorders2
Otoconia get “knocked loose” into semi-circular canals
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| show | mid 50's
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| show | episodic, typically short duration, fatigable, and symptoms correlate to head movements.
While the otoconia are loose, the pt experiences vertigo/dizziness/balance deficits
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| show | Canalithiasis- free floating otoconia
Cupulolithasis- otoconia adhered to cupula
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| canalithiasis BPPV symptoms | show 🗑
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| cupulolithiasis BPPV symptoms | show 🗑
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| dix hallpike position | show 🗑
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| what should you monitor in dix hallpike position? | show 🗑
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| show | Modified Dix-Hallpike
45 degrees cervical rotation, down on opposite side.
Ex: Right cervical rotation, lay down to the L to test the L ear.
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| show | Best for patients who have limited neck extension ROM
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| original canalith repositioning procedure 5 key elements (now the epley) | show 🗑
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| gold standard for posterior canal canalithaiasis | show 🗑
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| steps for epley for PSCC BPPV | show 🗑
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| show | 85-95%
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| foster half summersault is for what type of BPPV? | show 🗑
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| tests for horizontal canal involvement | show 🗑
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| what is bow and lean test used for? | show 🗑
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| vestibular neuritis | show 🗑
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| show | Viral or bacterial infection involving the entire labyrinth
Spontaneous onset of vertigo, nausea, emesis, imbalance etc.
Key difference from Vestibular neuritis: auditory symptoms present
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| what is damaged in vestibular neuritis/labyrinthitis? | show 🗑
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| show | Labyrinthitis, neuritis, tumors/neuroma resections
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| show | specific vestibular exercises over regular exercise
Gaze Stability Exercises
Research also supports task specific exercise
Do the movements that cause dizziness
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| show | Generally good
Only about 10-30% of subjects with UVH do not experience improvement
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| show | much differently than unilateral
Dizziness and vertigo are less common
Pt typically with significant imbalance and oscillopsia
Loss of VOR
Typically a result of ototoxicity
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| what can cause ototoxicity | show 🗑
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| what type of nystagmus will be seen with posterior semicircular canal BPPV | show 🗑
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| show | geotropic or ageotropic
strongest, most intense, largest velocity nystagmus going toward the most symptomatic side
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| what type of nystagmus will be seen with anterior semicircular canal BPPV | show 🗑
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