Vestibular Rehabilitation

Consists of : conditions treated by VR

.
Winer ear Peripheral disorders

Vestibular cochlear nerve vestibular nuclei in vestibular system of inner ear , and vestibular nerve
→
signals
- -

The pans of brainstem Benign paroxysmal venigo ( BPPV)

.

t medulla . positional
'

cranial nerves vestibular neuritis

-

additions
.

menieres

nouveau
) eye movement .

Vestibular Schwann ma

oculomotor

vestibularspinal tracts central causes

cerebellum -

vestibular migraine
-

cerebral cortex
.
Ms

.
stroke ( posterior fossa)

Role of Vestibular system .

TB1

sensory motor

motion -

Balance Other conditions

head position related dizziness imbalance

posture Age
'

t
.
-
-

'

spatial orientation
.

stabilise head 1 body .

visually induced dizziness

during movement

Aims
~
Estimates body position and motion .

Improve gate stability resume Abls Improve confidence

+
improve postural control t

vision
\nfeNgfah ] .cn
Improve motion sensitivity t fans
✓
Resume vocational role

vestibular motor commands Treatment Decisions

proprio captive Repositioning

]
-

manoeuvre

meohano receptors
-

Habituation
motion
✓ .

Gaze stability
-

Adaptation or substitution

Balance
.

Vestibular Rehab .
Gait

graded exercise approach

.

comprises eye # head movements to stimulate BPPV

the vestibular system calcium carbonate crystals become animated into

'
Avin :
promote compensation or neuro plastic semi -
circular canals , create irritation and a sense

adaptation of movement .

to alter
input from damaged system Sx signs
Mut challenge balance holistically target vehigo
1
spinning changing position
-
- -
: when

motor
.

Short duration : seconds -

minutes

sensory
'

cognitive Dix Hallpike

'
-

Balance should be automatic but the ability 450 head turn

'

to
'

compnnined Therefore hit them down

dual tone this suddenly
'

be
may
.

keepeyesopeni.MY
- Bus
should also be wait mate
targeted 30 seconds
.
-
I minute

'
Good orientated specific ! repeat on other side
- '

t
geo trophic nystagmus
Affected side .
-

ear facing down

 BBQ Roll 1 tempest )
Complete
oeu¥
lust , as will make them feel unwell
! man

towards
affected
Cl : unstable neck # AS , Pa downs
gets syndrome
,
side
,

+ neck ROM

3600 movement

torsional 801 all eats

-
geohrophic nystagmus = .
posterior canal

-then
sitting
Rx
E-
play 's Manoeuvre -

80% elleuive on the tint time .

Gufoni Manoeuvre

*
oupuloliatheris

then sit
up
a

Canal olithiasis Cupulolithiasis

'
Well tolerated
EH ④it
- -

may need second person to look at eyes of patient to

-

&
②
,

↳÷÷f÷
kai Baa
whilst one manoeuvres them

detain t
40 second Adheres to
inputa
free floating latency
Types of BPPV
→
Immediate onset -

persists
801 Canal ithiasis otoconia free float in
crystals lndolyhhetic
. -
.

space summary
20% .
lwpulolithiasis .
otoconia crystals attain to input of posterior trcanal BPPV Horizontal canal BPPV
t
the semi circle canals
-
Dix Hall pike Roll test

epley 's J→ semonts BBQ routes ttufoni

SlMmt manoeuvre canaloliatm.ws cupuloiiathisis
canal oliathih's cwpuloliathisis

key factor speed =

→ olica off of me Document

of the
'

would consent

uvpula tent performed It side assessed )

'

presence of nystagmus
'

latency
-

direction
'

Horizontal canal BPPV .

duration

Affects 101 of patients

.
'

modifications to
testing for precautions

No genomic nystagmus on die hallpike

-
. . .
try :
'
conclusion

diagnosis
'

Roll Test -

type of Bppv
'

post
-

treatment advice ?

may feel unsteady

'

more

driving immediately
-

No

.
No hairdresser 1 dentist 48 hrs

}
slowly switch sides
 Habituation Exercises However may be useful it patient unable to

Aim : to reduce dizziness through repeated exposure complete BPPV manoeuvre positions for any reason .

to specific movements or visual stimuli

Gate stabilisation form of

-

which provoke symptoms one habituation

-

ex
-

→
Adaptation
Iv number of synaptic connections on motor → substitution

and interneurons . But takes time to elicit

changes !
Will
initially make symptoms work , but improve Adaptation
them in the
long term .
Used to readjust the vestibular -

ocular reflex for

to be stable whilst head
eyes moving .

To desensitise
patient to
provoking stimuli .

perform head movements with the

eyes in focus
'

requires intact cerebellum t brainstem

Based on
CooksHiies . . .
but didn't
l
posterior fossa stroke unlikely to work

wiilude Not customised part of brain

gate stains onion .

enough as
already damaged .

for patients .

( sufficient Exercise prescription

poor compliance if given out without :

direction 5110
trigger
N
dizziness
'
.

'

subside in 720 minutes

Exercise Prescription
can be used for any wittiness condition
I
venigo .

for example :

pick main impairment

alluring activity I panicipalion
-
.

progression
-

Target things which are difficult ie

scrolling on Pc .

stand feet apart

or
walking down
busy supermarket
→ should induce feet together
-

5110 Should settle wi

intensity of dizziness felt tandem
i

.
n 20 mins . in

-
No strong evidence for number of reps, but
.
on cushion

Commonly 3- SX daily minutes each busy background

,
I -2 movement
'

-
Use neuroplasticity principles -
repetitive 1 intense etc .
dum task

Example exercises substitution

*
struggling we -
sit Another sensory input towing over to produce motor

'

SOEOB ( progress speed 1 reps ) output .

Useful in caves of central damage eg .
stroke .

*
scrolling PC UM Mellie , but med in deficits which can't be fixed .

f. Slowly 11 minute → 2 mins)

faster pace Train cephalic ocular reflex stabilises eyes

{
when
-
.

more
frequent turning head Generally shower reflex
.

. much .

*
Watching videos of walking in crowds But with training can become faster and compensate
for mining von .

Brandt -
Dowoff Exercises I originally BPPV )
'

turning head ↳ ineffective ! ! focus head refocus etc

)
eyes more more eyes more
- -
- -

side " "

lying "
'

on

X - soon Y
IYIL.ea.ae
-
a
i. look @
keep head
look @ y
tum head to Y
still
fw2minu①
 move eyes and head simultaneously MCD for balance t vestibular disorders = 6 pts

more targets further apart MCID for vestibular disorders = 8 points

✓ me bury 1 mining background
Exercises
Imbalance / Falls .

postural transitions ie
change of direction
Body needs to adapt t
respond to
changes in the Head orientation

environment . Backwards

looks at how
you integrate the
sensory information changing Bos ie tandem walking
-

relieved for balance varying speed of walking

'

'
Terrain -

obstacles under mat 1 inclines

Balance modified tent for sensory integration and Dural ie 1

tasking
-

counting conversation
.

balance (MC5-1IB) . Wii 1 virtual

reality

condition Details sensory system

'
firm surface somatosensory
eyes open vision

Vestibular

2
firm surface somatosensory
eyes wore vestibular

4
foam surface vestibular

eyes open vision

5
foam surface vestibular

eyes closed

3 trials of each condition

30 seconds each trial

depends Rx 9
Depends which pattern
as on
specific
target area found difficult in MCTSIB
'

manipulate standing position surface +

'

me of vision
-

look at reactive balance

ankle
sway
-

hip sway
'

stepping correction
'

look at anticipatory
'

balance

mini BEST also useful -

tests all the above

G-ait

functional gait Ax
10 item outcome measure scored 0-3
'
-

postural stability during walking

'