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Vetsibular (Contraindications to vestibular rehab (Meniere's disease…
Vetsibular
Contraindications to vestibular rehab
Meniere's disease by itself
Uncontrolled migraine
Perilymph fistula
Unrepeared superior semicircular canal dehiscence
sudden loss of hearing
increased feeling of pressure or fullness to the point of discomfort in one or both ears
Severe ringing in one or both ears
post surgical
acute neck injuries
Diagnoses involving the vestibular system
Meniere's Disease
Low frequency hearing loss, episodic vertigo
Can cause UVH
Perilymphatic fistual
PT contraindicated for these pts
Vestibular schwannoma
Benign tumors from the schwann cells of CN VIII
Motion sickness
Migraine-related dizziness
Can present similarly to BPPV or UVH
MS
Can affected CN VIII, presents similarly to UVH
Multiple system atrophy
Progressive, degenerative
Cervicogenic dizziness
Physiology and motor control
Tonic firing rate
~70-100 spikes/sec
vestibulo-ocular reflex
Image on fovea during rapid head movements
Gain/velocity
Phase/amplitude
Gain <60 degrees/sec --> smooth pursuit
Gain >60 degrees/sec requires VOR
Push-pull Mechanism
Turning R, R SCC increases firing rate, L decreases firing rate
Inhibitory cutoff
Opposite labyrinth inhibition can only reach zero
Velocity storage system
Cupula signal lasts as long as it is displaced
Helps to detect low frequency head rotation
Interventions
BPPV
Tx
Eply maneuver
Liberatory semont maneuver
Brandt daroff exercises
Unilateral vestibular hypofunction
Should resolve in 3-7 days
Bilateral vestibular hypofunction
Abnormal central vestibular function
Patient education
Anatomy
Peripheral vestibular system
Otolith organs (linear)
Semicircular canals (angular)
Central vestibular system
Cerebellum
VOR
PT Examination
History and Systems Review
Category of dizizness
Vertigo
Lightheadedness
Dysequilibrium
Oscillopsia
Duration of symptoms
seconds to minutes --> BPPV
Minutes to hours --> Menieres disease
Tests and Measures
VAS
DHI
FDS
MSQ
Examination of eye movements
Observation of nystagmus
Fast --> parapontine
Slow --> VOR
Named for the fast component
Peripheral vestibular lesion
Unilateral vestibular lesion
Involved side is opposite of fast component
Head impulse test
Head shaking induced nystagmus test
Positional testing
Dix Hallpike
Dynamic visual acuity test
Roll tests
Vestibular system dysfunction
Peripheral pathology
Mechanical
Cupulothiasis --> longer dizziness duration
Canalithiasis
Decreased receptor input
Unilateral vestibular hypofunction
Bilateral vestibular hypofunction
Central Nervous system Pathology
AICA
PICA
Vertebral artery
Can mimic peripheral vestibular hypofunction
Dysdiadochokinesia
Vertical nystagmus