Vestib: interventions Flashcards by Chavez Girls

prognostic indicators

CNS slower recovery and quicker plateau than peripheral

bilateral harder to recover than uni

chronic or reoccurring harder to recover than acute

BPPV most responsive to treatment

comorbidities neg affect as well

older age female

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if pt has BPPV, treat it

FIRST

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WITH bppv, there is a high rate of occurrence: ___% will recur within 2 years

50%

thats why HEP is important so they can treat themselves

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CPG says for post-maneuver precautions, you should

NOT give the laying at 45 degree for two days instructions

INSTEAD

give HEP

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sudden hearing loss is

a medical emergency (to preserve hearing)

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if hall pike is negative, but you think they are + what do you do?

roll test
and
sidelying test

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dix hallpike tests what?

PSC
ASC

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how to identify canal affected in dix hall pike for anterior?

dont go by functional pairs

*direction of nystagmus and rotation

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hearing loss and tinnitus prognosis

sometimes recovers fully, often permanent
no therapy option but hearing aids

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what three things make up postural control?

task - get to chair
environment - going up ramp
individual -vision is disorganzied, need to rely on vestibular system

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how is BPPV managed?

spontaneous remission or recovery

canalith respositioning maneuver CRM

surgery

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what to do before giving patient HEP?

pt should be provided with following precautions prior to performing independent exercise.

Red flags to stop:
-sudden loss of hearing or fluctuations in hearing
-increases pressure and or fullness to point of discomfort
-discharge of fluid from ear
-servere ringing in the ears

*if any of the above symptoms occur, STOP exercise immediately and contact physician

NOTE: these are also red flags for treatment!!

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canalith repositoning using

gravity and momentum

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canalithiasis = repositioning maneuvers are done ____

cupulolithiasis = repositioning maneuvers are done ___

slow

fast

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what treatment maneuver for posterior canal?

CRM (Epley)
Semont

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what treatment maneuver for anterior canal?

Reverse Semont

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what treatment maneuver for horizontal canal?

Log/BBQ Roll, Gufoni (Casani/Appiani)

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during BPPV interventions should you use Frenzels?

YES to observe nystagmus!

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ex:
+ left hallpike

L posterior canal canalithias
what do you see in frenzels

upbeating
L torsional
canalithisis: symptoms come on after few seconds and off, intensity of nystagmus goes down then away when dizziness goes away.

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if vertigo + nystagmus is elicited during dix hallpike OR sidelying test immediately take patient through ____

CRM with frenzels

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explain canalith repositioning maneuver CRM

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how long does CRM take

2.5 mins

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when doing dix hall pike what ear are you testing?

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the downward ear

ex: if testing right –> rotate head to R

what is the dump position

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tucks pt chin so nose is pointed to mat/floor

post CRM HEP (dosing instructions)

perform self CRM at home the next morning and if vertigo is STILL present then repeat self CRM every morning until vertigo free for 3 days in a row

Pt is unable to perform self CRM at home what do you do?

give Brandt Daroff Habituation exercises

HEP: self CRM or Home Epley Maneuver

sit in bed with 2 pillows behind middle back, hold onto pillows turn head to L and extended over pillows with head resting on bed and not on pillow then turn head slowly to R then turn body slowly to R while tucking chin in and pointing nose into bed return slowly to sitting Stay in each position for 30s or until symptoms subside + 30s. Perform 1 reps every morning until no symptoms for 3 days in a row. Record symptom intensity and duration on HEP log.

Semont Maneuver to treat what

PSC cupulolithiasis

when is sermont maneuver used?

PSC cupulolithiasis alternative txt to epleys if cervical extension is limited or pt cant achieve supine or roll

how to turn head for beginning of sermont maneuver?

45 degrees in opposite direction to affected PSC (sidelying test starting position)

for semont maneuver Pt quickly moved to sidelying toward affected side while examiner keeps head position turned 45 degrees so pt is looking at ______ explain the rest

ceiling (nose up) affected posterior canal now hitting the mat! wait 1 min quickly move in upward arc through sitting to opposite side-lying position with examiner maintain head alignment so that pt is looking down (nose down) with head flexed at least 30 deg (head dump) nystag and vertigo should reappear in this position, if not shake head 1-2x to free debris and have pt stay in position for 1 min slowly move to sitting while keeping head in 30 deg flex, wait 1 min return head slowly to neutral, wait 1 min

semont maneuver for PSC cupulolithiasis how many times do you repeat

repeat 2-5 times in one sessions; symptoms should fatigue or lessen in intensity with repetition (perform 2 reps on practical)

after performing the semont, what might you have to do after?

may have to do CRM because the crystals are unstuck and it now becomes canalithiasis

Pt hall pike - roll test - but swear you think its PSC what do you do? becuase look up over and R dizzy what

sidelying test R sidelying test is + for RPSC -symptoms come immediately and stay until out of position -upbeat and R torisonal

semont vs CRM timing of each

semont - 1 min CRM - 30secs

semont where does patient hold onto PT?

forearms

how long does each semont take

4 minutes 20-30 mins to do treatment

R posterior cupulolithiasis is affected what way to turn head for semont?

L b/c ear done is canal that is stimulating

reverse semont (liberatory) maneuver to treat what?

ASC canalithiasis or cupulolithiasis

Pt cant do CRM b/c of cervical spine what do you do?

semont *note that cant do dix or CRM if cervical spine isnt clear!

reverse semont maneuver what way do you turn the head?

towards affected ASC side (starting position of sidelying test) turn head to LEFT

pt has L ASCC canalithiasis how do you know?

down beat and L torison delayed nystagmus, positional *go by nystagmus

left hall pike patient gets downbeat and L torison what is dx?

L ASCC canalithiasis

reverse semont when Pt comes back up what way is face facing before neutral?

keeping head turned 45 degrees towards affected side

HEP for PSC and ASC cupulolithiasis

perform 3-5 reps once daily until vertigo free x 3 consecutive days

reverse semont is only for what treatment?

only anterior canal!!!! *pace for canal - slow cup - fast

what is the BBQ or Log roll for

HSC canalithiasis

what position does patient begin in? For BBQ / log roll

begins in roll test position of affected side (supine w head flexed 30 degrees and rotated 90 degrees towards affected ear) - side that causes more nystagmus and vertigo during roll test

ex: Pt has L HSC canalithiasis what do we see?

geotrophic nystagmus intensity worse on L affected ear intensity comes on slowly and goes away

BBQ does patient roll towards or away from affected side?

away

what is dump position for BBQ or log roll

prone with head into plinth as PT maintains neck flexed 30 *can use pillow under chest or prop on forearms

Casani aka Gufoni tx is for what

HSCC Cupo

casani description

pt starts isttign at edge of mat w head neutral and nose forward ask pt to QUICKLY lie down on affected side (side of weaker apogeotropic nystagmus) while you maintain neutral head position (PT holds it) for 2 min or until s/s stops examiner then quickly rotates pts head 45 degrees away from affected side (nose up) to dislodge the otoconia and holds 2 min slowly return to sitting w head still in same position (rotated 45 deg, PT holds) wait 2 min then slowly bring head to neutral position repeat 2-5 times

HEP for HSC Cupulo

self-casani pt starts sitting up, quickly lies onto affected ear with head neutral (use pillow!) quickly turns head 45 deg nose up slowly sit up with head still rotated then neutral head

HEP for HSC Canal

forced prolonged positioning start by lying on affected ear for 1 min then lie on your back for 1 min, then quickly roll so that you are lying on your unaffected ear and sleep in this position for the night, place pillows behind you to keep you in this position in the morning, finish the self-BBQ roll (roll to prone, then other side to finish circle) perform once every night/morning until vertigo free for 3 days

Brandt-Daroff Habituation Exercise

nonspecific, evidence is not great but know it for your written

Vestib: interventions Flashcards

(56 cards)