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MODULE 10: VESTIBULAR REHABILITATION (VESTIBULAR SYSTEM "Inner ear…
MODULE 10: VESTIBULAR REHABILITATION
VESTIBULAR SYSTEM
"Inner ear balance", 'equillibirum' - Head/eyes/postural control. Based on Vestibulo-Occular (coordination of head and eye movements together) and Vestibulo-Spinal reflexes (Maintenence of balance and posture during head movements
PATHOPHYSIOLOGY
: Boney and membranous labyrinth, with 5 sensory organs. 2 Otoliths, and 3 semicircular canals. Hair folics and fluid filled
DEFINITION
COMMON CAUSES OF DYSFUNCTION
Idiopathic
Tumours
Infections
Blood Pressure Issues
Trauma/Head strike
TYPES
NEUROLOGICAL
Vascular (especially psoterior circulation)
VBI
Trauma
Demyelinating conditions
Intercranial tumours
Cerebellar Disorders ie MSA
Migraine associated Vertigo (VM) (10% of all presentations to migraine clinics)
OTHER
Anxiety
Panic Disorders
Middle Ear Infections
Cervicogenic
Sinovitis
Medication Side Effects
Hypotension
Orthostatic
Postural
OTOLOGICAL
UPVD
Vestibular Neuritis
Labrynthitis
Acoustic Neuromas
Meniere's
Benign Paroxysmal Positional Vertigo (BPPV)
Perilymphatic fistula
Ototoxicity
Superior Canal Dehhescence
COMMON CONDIITONS
Migraines
Assessment
Treatment
Characteristic Symptoms
Neuritis/Labrynthitis
Assessment
Treeatment
Characteristic Symptoms
BPPV
: Most common type, cause of 50% of dizziness in elderly patients, more common in over 65's
Characteristic symptoms
Assessments
Hallpike Dix
Head Shake Test
Interventions
Epley's Manoeuvre
Brandt Daroff Exercises (habituation)
Common Causes of Dysfunction
Hereditary
Ischemic
Prior Neuritis
Post Operatively (Ear of general surgery)
Meniere's Disease
Idiopathic
Prolonged Bed Rest
Migraines
PHYSIOTHERAPY
ASSESSMENT
SUBJECTIVE
Senses: Vision - glasses?, Hearing baseline, Tinnitus?
PMHx ie previous neuromas, surgeries, peripheral neuropathies, etc
Medications!
RED FLAGS (Refer to GP or Neurologist!)
Neurological signs ie dysarthria, diploplia, reduced coordination
Non responsive to treatment
Downwards nystagmus
Nystagmus but no vertigo
Sudden hearing loss
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OBJECTIVE
Occulo-Motor
Saccades
VOR Suppression
Smooth Pursuit
Nystagmus
Vertical
Downward (Central)
Skew Deviation (Alternate Cover Test)
Head Impulse Test
Neck
Neurological (power, tone, coordination, balance, proprioception)
Vestibular
Vestibular Occular Reflex (VOR)
Balance
Gait
TREATMENT
Education
Manoeuvres - see BPPV)
Referral on
Habituation Retraining
Temporary mobility aid prescription
Eye patches
EMERGING TECHNOLOGIES
Goggles
MEDICAL INTERVENTIONS
MEDICATIONS
: Anti-nausea
EVIDENCE
Evidence
GAPS IN KNOWLEDGE
Other conditions besides BPPV
Specific assessments
Vestibular System: Definition, Roles and Pathophysiology