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Vestibular Physiotherapy - Pre Module - Coggle Diagram
Vestibular Physiotherapy - Pre Module
Anatomy
Peripheral sensory apparatus - Ant, Post & Horizontal canals, Otoliths, Vestibular nerve
Central - Vestibular nuclei, Vestibulospinal tract, Autonomic NS
Central causes of dizziness/ vestibular symptoms
CVA/ TIA
Vertebrobasilar Insufficency
Vestibular migraine
Concussion
Peripheral causes of dizziness
Vestibular Neuritis
may be caused by recent illness or vestibular nerve damage
Benign Paroxysmal Positional Vertigo (BPPV)
Canalithiasis - up to 60sec latency + nystagmus
Cupulolithiasis - more sustained symptoms, unchanging whilst head is in provoking position
Meniere's disease
Labrynthitis - similar presentation to Neuritis + unilateral hearing loss
Acoustic Neuroma
Peripheral treatments
Epley's Manouevere
BBQ roll
Sermont
Deep hang test
Objective Assessment
VBI screening
Cervical ROM
Oculomotor Ax (Eye ROM, visual fields)
Dynamic Visual Acuity Test
HINTs exam (Head Impulse Test, Nystagmus, Test of Skew)
Head Impulse Test
Subjective Assessment
Date of 1st onset
Position of symptom onset
Duration of symptoms (constant, intermittent)
Associated symptoms
- nausea, vomiting, sweating, diplopia, drop attacks, Pins/needles/ numbness, headache, tinnitus, hearing loss, bodily sounds (heartbeat in ears), photophobia, dysarthria, dysphagia, muscle weakness
Recent illness
Recent surgery, trauma or injury to the head or ear
Effectiveness of medication i.e. Stemetil
Past Medical Hx
Other medications i.e. recent Antiobiotics, Chemotherapy, Steroid use
Vestibular Screening Tool (4 questions)
Assessment Red flags/ contraindications
Severe Rheumatoid Arthritis
Neck trauma
Vascular Dissection syndromes
Atlantoaxial & Occipitalatlanto instabilty
Role of Vestibular System
Balance & hearing
Push-pull system, if one side is not working well, will create disequilibrium