Vestibular Rehabilitation Therapy - MCCCbehrensb/documents/VestibularRehabilitationThera… · What...
Transcript of Vestibular Rehabilitation Therapy - MCCCbehrensb/documents/VestibularRehabilitationThera… · What...
![Page 1: Vestibular Rehabilitation Therapy - MCCCbehrensb/documents/VestibularRehabilitationThera… · What is Vestibular Rehabilitation Therapy (VRT)? VRT is an exercise-based program designed](https://reader034.fdocuments.net/reader034/viewer/2022042619/5a70b7c97f8b9a9d538c3b61/html5/thumbnails/1.jpg)
Vestibular Rehabilitation Therapy
Melissa Nelson
![Page 2: Vestibular Rehabilitation Therapy - MCCCbehrensb/documents/VestibularRehabilitationThera… · What is Vestibular Rehabilitation Therapy (VRT)? VRT is an exercise-based program designed](https://reader034.fdocuments.net/reader034/viewer/2022042619/5a70b7c97f8b9a9d538c3b61/html5/thumbnails/2.jpg)
What is Vestibular Rehabilitation
Therapy (VRT)?
VRT is an exercise-based program designed to
promote CNS compensation for inner ear deficits.
The goal of VRT is to retrain the brain to recognize
and process signals from the vestibular system in
coordination with vision and proprioception.
This often involves desensitizing the balance system
to movements that provoke symptoms.
![Page 3: Vestibular Rehabilitation Therapy - MCCCbehrensb/documents/VestibularRehabilitationThera… · What is Vestibular Rehabilitation Therapy (VRT)? VRT is an exercise-based program designed](https://reader034.fdocuments.net/reader034/viewer/2022042619/5a70b7c97f8b9a9d538c3b61/html5/thumbnails/3.jpg)
Why is VRT needed?
When the vestibular organs are damaged with disease or injury, the brain can no longer rely on them for accurate information about equilibrium and motion.
Dizziness
Vertigo
Balance problems
Nausea
Headaches
Nystagmus
![Page 4: Vestibular Rehabilitation Therapy - MCCCbehrensb/documents/VestibularRehabilitationThera… · What is Vestibular Rehabilitation Therapy (VRT)? VRT is an exercise-based program designed](https://reader034.fdocuments.net/reader034/viewer/2022042619/5a70b7c97f8b9a9d538c3b61/html5/thumbnails/4.jpg)
Spontaneous Nystagmus
Nystagmus
Involuntary osciliation of the eyes
Typically has a fast and a slow component
that alternate in opposite directions
The direction of the fast component defines
the direction of the nystagmus
![Page 5: Vestibular Rehabilitation Therapy - MCCCbehrensb/documents/VestibularRehabilitationThera… · What is Vestibular Rehabilitation Therapy (VRT)? VRT is an exercise-based program designed](https://reader034.fdocuments.net/reader034/viewer/2022042619/5a70b7c97f8b9a9d538c3b61/html5/thumbnails/5.jpg)
What are the effects of VRT and how
does it help?
Some exercises and activities may at first
increase in symptoms as the body and brain
attempt to sort out the new pattern of
movements
However, in most cases balance improves
over time if the exercises are correctly and
faithfully performed
VRT is very successful
![Page 6: Vestibular Rehabilitation Therapy - MCCCbehrensb/documents/VestibularRehabilitationThera… · What is Vestibular Rehabilitation Therapy (VRT)? VRT is an exercise-based program designed](https://reader034.fdocuments.net/reader034/viewer/2022042619/5a70b7c97f8b9a9d538c3b61/html5/thumbnails/6.jpg)
Anatomy of the EAR
![Page 7: Vestibular Rehabilitation Therapy - MCCCbehrensb/documents/VestibularRehabilitationThera… · What is Vestibular Rehabilitation Therapy (VRT)? VRT is an exercise-based program designed](https://reader034.fdocuments.net/reader034/viewer/2022042619/5a70b7c97f8b9a9d538c3b61/html5/thumbnails/7.jpg)
Inner Ear
![Page 8: Vestibular Rehabilitation Therapy - MCCCbehrensb/documents/VestibularRehabilitationThera… · What is Vestibular Rehabilitation Therapy (VRT)? VRT is an exercise-based program designed](https://reader034.fdocuments.net/reader034/viewer/2022042619/5a70b7c97f8b9a9d538c3b61/html5/thumbnails/8.jpg)
Inner Ear
The boney labyrinth is a series of hollow
channels
Central chamber: Vestibule
Anterior chamber: Cochlear
Posterior chamber: Vestibular
![Page 9: Vestibular Rehabilitation Therapy - MCCCbehrensb/documents/VestibularRehabilitationThera… · What is Vestibular Rehabilitation Therapy (VRT)? VRT is an exercise-based program designed](https://reader034.fdocuments.net/reader034/viewer/2022042619/5a70b7c97f8b9a9d538c3b61/html5/thumbnails/9.jpg)
Pathophysology of Common
Vestibular Disorders
Vestibular Neuritis
Benign Paroxysmal Positional Vertigo (BPPV)
Labryrithitis
Inflammation of the inner ear caused by a virus
Meniere’s Disease
Overproduction of endolymph that causes edema of the endolymphatic spaces and damages hair cells in the cohlea and vestibular organs
Acoustic Neuroma
Cervical Vertigo
Head Trauma
![Page 10: Vestibular Rehabilitation Therapy - MCCCbehrensb/documents/VestibularRehabilitationThera… · What is Vestibular Rehabilitation Therapy (VRT)? VRT is an exercise-based program designed](https://reader034.fdocuments.net/reader034/viewer/2022042619/5a70b7c97f8b9a9d538c3b61/html5/thumbnails/10.jpg)
BPPV
The most commonly seen in physical therapy clinic
It accounts for 6 million clinic visits in U.S. every year
Positional Vertigo
Spinning sensation caused by changes in head position
Prone to Supine/Supine to Prone
Looking over your shoulder
Blow drying your hair
![Page 11: Vestibular Rehabilitation Therapy - MCCCbehrensb/documents/VestibularRehabilitationThera… · What is Vestibular Rehabilitation Therapy (VRT)? VRT is an exercise-based program designed](https://reader034.fdocuments.net/reader034/viewer/2022042619/5a70b7c97f8b9a9d538c3b61/html5/thumbnails/11.jpg)
BPPV Symptoms
Vertigo
Short Duration (Paroxysmal)
Lasts seconds to minutes
Positional onset
Nausea
Nystagmus
Last about 30 seconds or more
Syncope
Fainting spells during positional change
![Page 12: Vestibular Rehabilitation Therapy - MCCCbehrensb/documents/VestibularRehabilitationThera… · What is Vestibular Rehabilitation Therapy (VRT)? VRT is an exercise-based program designed](https://reader034.fdocuments.net/reader034/viewer/2022042619/5a70b7c97f8b9a9d538c3b61/html5/thumbnails/12.jpg)
Cause of BPPV
Within the labyrinth of the inner ear lie collections of calcium crystals known as otoconia.
In patients with BPPV, the otoconia are dislodged from their usual position within the utricle.
They migrate over time into one of the semicircular canals (the posterior canal is most commonly affected due to its anatomical position).
When the head is moved against gravity, the gravity-dependent movement of the heavier otoconial debris ("ear rocks") within the affected semicircular canal causes abnormal endolymph displacement causing vertigo to occur.
![Page 13: Vestibular Rehabilitation Therapy - MCCCbehrensb/documents/VestibularRehabilitationThera… · What is Vestibular Rehabilitation Therapy (VRT)? VRT is an exercise-based program designed](https://reader034.fdocuments.net/reader034/viewer/2022042619/5a70b7c97f8b9a9d538c3b61/html5/thumbnails/13.jpg)
Otoconia
“Ear Rocks”
![Page 14: Vestibular Rehabilitation Therapy - MCCCbehrensb/documents/VestibularRehabilitationThera… · What is Vestibular Rehabilitation Therapy (VRT)? VRT is an exercise-based program designed](https://reader034.fdocuments.net/reader034/viewer/2022042619/5a70b7c97f8b9a9d538c3b61/html5/thumbnails/14.jpg)
Development of the Treatment Plan
for a Person with a Vestibular Disorder
Oculomotor
Exam
Motion
Provoked
Testing
Functional
Limitations
Balance
Patient
Complaints
(Dizziness,
Imbalance)
Treatment
Plan
![Page 15: Vestibular Rehabilitation Therapy - MCCCbehrensb/documents/VestibularRehabilitationThera… · What is Vestibular Rehabilitation Therapy (VRT)? VRT is an exercise-based program designed](https://reader034.fdocuments.net/reader034/viewer/2022042619/5a70b7c97f8b9a9d538c3b61/html5/thumbnails/15.jpg)
What happens during VRT?
PT will perform a thorough evaluation that begins with
Symptoms
Describe the symptoms
Try not to use the word dizzy
Dizziness can have several meanings
Modified Vertebral Artery Test
Past Medial history
Including Medication
Some medications can cause dizziness
Blood pressure medications
Antidepressant Drugs
![Page 16: Vestibular Rehabilitation Therapy - MCCCbehrensb/documents/VestibularRehabilitationThera… · What is Vestibular Rehabilitation Therapy (VRT)? VRT is an exercise-based program designed](https://reader034.fdocuments.net/reader034/viewer/2022042619/5a70b7c97f8b9a9d538c3b61/html5/thumbnails/16.jpg)
What happens during VRT?
Subjective Measure of Dizziness
Dizziness Handicap Inventory
Measure of self-perceived disability attributable to vestibular disease
Vertigo Symptom Scale
Consists of 2 subscales
Anxiety
Vertigo
Vertigo Handicap Questionnaire
Measures effect of vertigo on physical and social function
![Page 17: Vestibular Rehabilitation Therapy - MCCCbehrensb/documents/VestibularRehabilitationThera… · What is Vestibular Rehabilitation Therapy (VRT)? VRT is an exercise-based program designed](https://reader034.fdocuments.net/reader034/viewer/2022042619/5a70b7c97f8b9a9d538c3b61/html5/thumbnails/17.jpg)
What happened during VRT?
Dizziness Questionnaires
Can be useful to gather information from the
patient before they even come to the clinic
Can assist the therapist in ensuring important
questions regarding the history are asked and
answered
![Page 18: Vestibular Rehabilitation Therapy - MCCCbehrensb/documents/VestibularRehabilitationThera… · What is Vestibular Rehabilitation Therapy (VRT)? VRT is an exercise-based program designed](https://reader034.fdocuments.net/reader034/viewer/2022042619/5a70b7c97f8b9a9d538c3b61/html5/thumbnails/18.jpg)
Standardized Assessment Tools
During the initial examination the PT will use
balance and gait assessment tools:
Tinnetti Assessment Tool
Berg Balance Scale
Single Leg Stance, Romberg
Dynamic Gait Index
Functional Gait Assessment
Foam and Dome
![Page 19: Vestibular Rehabilitation Therapy - MCCCbehrensb/documents/VestibularRehabilitationThera… · What is Vestibular Rehabilitation Therapy (VRT)? VRT is an exercise-based program designed](https://reader034.fdocuments.net/reader034/viewer/2022042619/5a70b7c97f8b9a9d538c3b61/html5/thumbnails/19.jpg)
Vestibular Compensation Exercises
(CRP)
Canalith Repositioning Procedures
These procedures help reduce the feeling of
dizziness by moving tiny particles that are
stuck in a sensitive portion of the inner ear
Otoconia “calcuim crystals”
Epley Maneuver
Uses four 30 second position sequences
Semont Maneuver
The patient is quickly moved from lying on one side
to the other.
![Page 20: Vestibular Rehabilitation Therapy - MCCCbehrensb/documents/VestibularRehabilitationThera… · What is Vestibular Rehabilitation Therapy (VRT)? VRT is an exercise-based program designed](https://reader034.fdocuments.net/reader034/viewer/2022042619/5a70b7c97f8b9a9d538c3b61/html5/thumbnails/20.jpg)
Treatment Plan
The most effective treatment plan will be
individualized to the patient’s complaints,
impairments, and disabilities.
![Page 21: Vestibular Rehabilitation Therapy - MCCCbehrensb/documents/VestibularRehabilitationThera… · What is Vestibular Rehabilitation Therapy (VRT)? VRT is an exercise-based program designed](https://reader034.fdocuments.net/reader034/viewer/2022042619/5a70b7c97f8b9a9d538c3b61/html5/thumbnails/21.jpg)
Certification
Physical therapists and PTAs typically need a
week or two of intensive course instruction in
order to be certified in VRT.
Contact:
Vestibular Disorders Association (VEDA)
www.vestibular.org
![Page 22: Vestibular Rehabilitation Therapy - MCCCbehrensb/documents/VestibularRehabilitationThera… · What is Vestibular Rehabilitation Therapy (VRT)? VRT is an exercise-based program designed](https://reader034.fdocuments.net/reader034/viewer/2022042619/5a70b7c97f8b9a9d538c3b61/html5/thumbnails/22.jpg)
![Page 23: Vestibular Rehabilitation Therapy - MCCCbehrensb/documents/VestibularRehabilitationThera… · What is Vestibular Rehabilitation Therapy (VRT)? VRT is an exercise-based program designed](https://reader034.fdocuments.net/reader034/viewer/2022042619/5a70b7c97f8b9a9d538c3b61/html5/thumbnails/23.jpg)
Oculomotor Exam
Allows the clinician to examine the interaction
between the patient’s visual and vestibular
systems by having the patient perform a
variety of head and eye movements
![Page 24: Vestibular Rehabilitation Therapy - MCCCbehrensb/documents/VestibularRehabilitationThera… · What is Vestibular Rehabilitation Therapy (VRT)? VRT is an exercise-based program designed](https://reader034.fdocuments.net/reader034/viewer/2022042619/5a70b7c97f8b9a9d538c3b61/html5/thumbnails/24.jpg)
Quiz
What is Vestibular Rehab. Therapy?
A. Exercise Program designed for ears, eyes
and nose deficits
B. Exercise based program designed to
promote CNS compensation for inner ear
deficits
C. Rehabilitation for the middle ear
![Page 25: Vestibular Rehabilitation Therapy - MCCCbehrensb/documents/VestibularRehabilitationThera… · What is Vestibular Rehabilitation Therapy (VRT)? VRT is an exercise-based program designed](https://reader034.fdocuments.net/reader034/viewer/2022042619/5a70b7c97f8b9a9d538c3b61/html5/thumbnails/25.jpg)
Quiz
What are some symptoms of VRT?
A. Vertigo & Nystagmus
Sweating & Dizziness
Dizziness & High Blood Pressure
What is nystagmus?
A. Involuntary eye movement
B. Voluntary eye movement
C. No eye movement
![Page 26: Vestibular Rehabilitation Therapy - MCCCbehrensb/documents/VestibularRehabilitationThera… · What is Vestibular Rehabilitation Therapy (VRT)? VRT is an exercise-based program designed](https://reader034.fdocuments.net/reader034/viewer/2022042619/5a70b7c97f8b9a9d538c3b61/html5/thumbnails/26.jpg)
Quiz
VRT is not very successful
True False
What is the most common vestibular
disorder?
A. Vestibular Neuritis
B. Benign Paroxysmal Positional Vertigo
C. Head Trauma
![Page 27: Vestibular Rehabilitation Therapy - MCCCbehrensb/documents/VestibularRehabilitationThera… · What is Vestibular Rehabilitation Therapy (VRT)? VRT is an exercise-based program designed](https://reader034.fdocuments.net/reader034/viewer/2022042619/5a70b7c97f8b9a9d538c3b61/html5/thumbnails/27.jpg)
Quiz
What are the calcium crystals in the inner ear
called?
A. Osteophytes
B. Endolymphs
C. Otoconia
Anyone can do VRT?
True False
![Page 28: Vestibular Rehabilitation Therapy - MCCCbehrensb/documents/VestibularRehabilitationThera… · What is Vestibular Rehabilitation Therapy (VRT)? VRT is an exercise-based program designed](https://reader034.fdocuments.net/reader034/viewer/2022042619/5a70b7c97f8b9a9d538c3b61/html5/thumbnails/28.jpg)
References
Nall, R. (2012). Vestibular Therapy Exercises. http://www.ehow.com/way_5408684_vestibular-therapy-exercises.html
Vestibular Rehabilitation Therapy. (2012) http://vestibular.org-disorders/treatment/vestibular-rehab.php
Swan, L. & York, A. (2010). An Introduction to Vestibular Rehabiliation. Sylvania, OH.www.GLSEMINARS.com