Vestibular
Rehabilitation
HISTORY
· Cawthorne
and Cooksey – First clinicians to offer exercises for dizziness and vertigo.
· Harold
Schuknecht – Cupulolithiasis theory.
· John
Epley – Canalithiasis theory – Revolutionized treatment for BPPV.
DIFFERENTIAL
DIAGNOSIS FOR DIZZY PATIENT
· LIGHT HEADEDNESS – Feeling
that fainting is about to occur .(Causes – Hypotension, Hypoglycaemia, or
anxiety)
· DISEQUILIBRIUM –
Sensation of being off balance. (Causes – nonvestibular problems – decreased
somatosensation or weakness in the lower extremeties)
· VERTIGO –
Illusion of movement. (Causes- pathology within the vestibular periphery or
along the vestibular pathways)
· OSCILLOPSIA–
Experience that objects in the visual environment that are known to be
stationary are in motion.(Cause – Vestibular hypofunction)
DIAGNOSTIC TECHNIQUES
· Careful
history
· Clinical
examination – Assessment of eye movements, posture and gait
· HEAD IMPULSE TEST – Assess
semicircular canal function.
· HEAD SHAKING INDUCED NYSTAGMUS – Diagnosis of people with asymmetry of peripheral
vestibular input to central vestibular regions.
· POSTIONAL TESTING – To
identify whether otoconia have been displaced into the SCC BPPV. The Dix –
Hallpike test commonly used to verify displaced otoconia.
· DYNAMIC VISUAL ACUITY – Measurement of visual
acquity during self – generated horizontal motion of the head.
· POSTURE & BALANCE TESTING – Determination of a
patient’s functional status. Testing includes static balance, weight shifting,
automatic postural responses and ambulation.
PHYSICAL THERAPY INTERVENTION
Vestibular
Rehabilitation
refers
to interventions such as repositioning techniques, vestibular adaptation
exercises, habituation excercices, and general exercise to improve muscle
force, gait or balance.
· BENIGN PAROXYSMAL POSITIONAL
VERTIGO – Nystagmus is generated when SCC with displaced
otoconia are placed into gravity – dependent positions, as in the Dix-Hallpike
test.
TREATMENT
|
DIAGNOSIS
|
Canalith
Repositioning Maneuver (CRM)
|
BPPV
due to Canalithiasis
|
Liberatory
Maneuver
|
BPPV
due to Cupulolithiasis
|
Brandt-Daroff
Exercises
|
Persistent
BPPV unresolved with CRM/Liberatory
Residual
vertigo without nystagmus
Maybe
useful for the patient who cannot tolerate CRM.
|
· UNILATERAL VESTIBULAR HYPOFUNCTION
– Recovery
time upon initiating vestibular rehabilitation averages 6 to 8 weeks.
ü Primary focus – gaze and gait stability
exercises.
ü The
two primary paradigms of vestibular
adaptation are X1 (times 1) and X2 execises (times 2).
ü X1
– Patient is asked to move the head horizontally (and vertically if
appropriate) as quickly as possible while maintaining focus on a stable target.
ü X2
– Patient to move the head and target in opposite directions.
·
BILATERAL
VESTIBULAR HYPOFUNCTION – Designed to address the primary complaints of gaze
instability during head motion, disequilibrium, and gait ataxia.
ü
Other
recommended activities – execises in a pool and Tai Chi.
ü
Habituation
exercises do not work for the patient with a bilateral vestibular loss.
· CENTRAL VESTIBULAR LESION –
Time to recovery will be 6 months or more and may be incomplete.
ü Though
vestibular rehabilitation offers promise for treating persons with Traumatic
brain injury, it may not always be the treatment of choice due to its
irritative nature.
· NON VESTIBULAR DIZZINESS – Vestibular
rehabilitation techniques similar to
those patients with true vestibular pathology.
· CONCLUSION
The vestibular system requires movement to recover from most lesions.
The vestibular system requires movement to recover from most lesions.
