Please enable JavaScript.
Coggle requires JavaScript to display documents.
Vestibular Rehabilitation 2 - Coggle Diagram
Vestibular Rehabilitation 2
Anatomy & Function of
Vestibular System
Peripheral Sensory Apparatus
6 x sensory organs
2 x otilith
3 x semicircular
Cochlear
Otilith - responds to linear acceleration and head tilt
Saccule (vertical orientation)
Utricle (horizontal orientation)
Semicircular -
3 on each side (paired with canals on opposite side)
push-pull relationship. Eg turn head left, increase firing on left, decrease firing on right
head movement will stimulate canals on both sides simultaneously
hair cells, covered by cupula
Anterior-posterior movement and frontal = anterior and posterior canals
Horizontal motion = horizontal planes
Central Processor
Vestibular nuclear complex
Cerebellum
Motor Output Mechanism
Vestibulo-occular reflex
Keeps eyes focused while head is moving
Vestibulo-spinal reflex
Posture and balance during head movement
Causes of Vestibular
Dysfunction + Dizziness
Peripheral
BPPV
Unilateral peripheral vestibular disorder
Meniere's
Superior canal dehiscence
Central
Migrane
Stroke
VBI
Tumours
Demyelinating conditions
Other
Anxiety
Cervicogenic
Postural hypotension
What is the treatment of Vestibular
Dysfunction & Dizziness?
BPPV
Epley manouvere (posterior SCC)
Home exercises
Sermont (cupulothiasis posterior SCC)
Unilateral hypofunction
Gaze stabilisation exercises
Long term vestibular rehab/balance and gait retraining
What is BPPV?
What happens?
Crystals from otolith break away and fall into SCC
Posterior SCC most effected due to being gravity dependent
Characteristics
Vertigo <60sec
change in head position
unsteady gait/falls/postural instability
How do we help differentially diagnose?
Look at the direction of beating nystagmus
Nystagmus but NO vertigo = not BPPV
be aware of central signs
How do we assess a vestibular patient?
Subjective
past history
integrity of other sensory systems
Msk limitations
Other: neuro, heart disease, diabetes, migranes
Medications
Objective
Eye Movements
Occulomotor assessment
VOR testing
Dix Hallpike
Head Thrust
Dix Hallpike
head turned towards affected side
vertigo + nystagmus for positive
Functional: Balance & Gait
ensure you test provoking movements
RED FLAGS
Neuro signs
5 D's
Atypical nystagmus
Sudden hearing loss
Failure to respond to conservative rx