What is Meniere’s disease?
- disorder of the membranous inner ear where there is an increase in endolymph (volume and pressure changes)
- causes temporary hearing loss, tinnitus (ringing), vertigo (>20min x 2), feeling of fullness in ear
What are the components of the vestibular system?
Otolith organs: Utricle and Saccule
Semicircular canals
cochlea
What are the balance organs?
Otolith organs: Utricle and Saccule
Semiciruclar canals
How does the vestibular system tell the brain about movement?
Fluid in inner ear moves with movement which stimulates receptors sending signal to brain
What are the signs and symptoms of vestibular issues?
- Vertigo
- Dizziness
- Dysequilibrium
- Nausea
- Disorientation
- light headed
How do you uptrain the somatosensory system?
- use of weights
- Eyes closed
- No shoes
- change of surface
- single leg stance
How do you decrease visual dependency?
- Quick head turns
- Walk backwards
- ball toss
- Eyes closed
- low lights
How do you uptrain the vestibular system?
- Tandem/Semi-tandem stance and walk
- Walk with head or eye movement
- Change of surface level
- walk backwards
How do you habituate to motion?
- head turns
- Eye movements: gaze stabilization and smooth pursuit
- Whole body changes
- Riding elevators
- Riding in cars
What is uptraining?
Substitution of alternate strategies???
What interventions are indicated for vestibular issues?
- Adaptations
- Substitutions of alternate strategies (uptraining)
- Repositioning maneuvers
- Habituation
- Balance retraining
When performing habituation exercises what is necessary?
must provoke symptoms at the level the client can manage
What is the VOR and its function?
Vestibular Occular Reflex- Maintains gaze stabilization when the head moves to make vision clear
-When head moves VOR provides compensatory eye movement to keep objects in focus
Which cranial nerves impact the VOR?
Motoneurons of cranial nerves III, IV, and VI
What is the VSR and its function?
Vestibulospinal reflexes- affect whole body equilibrium by facilitating and inhibiting skeletal extensor muscle activity (postural responses based on otolith afferent inforamtion)
Ex: when laterally tilt head, stimulate otoliths and semicircular canals causing VSR to activate the extensors on side laterally flexing to and flexors of the contralateral side
What are examples of reduced vesibluar function Peripheral Vestibular disorders?
Reduced vestibular function:
- labyrinthitis
- neuronitis
- age related degeneration of hair cells
- drug induced ototoxicity that damage hair cells
- brain trauma
- vascular occlusions
What are examples of distorted vestibular function Peripheral Vestiblar disorders?
It’s an inaccurate tansduction of sensory stimuli
-BPPV- otoconia from utricle displaced into semicircular canals
What are examples of fluctuating vestibular function peripheral vestibular disorders?
-changes in endolymph fluid and electrolytes
(ie Meniere’s disease)
-Periplymphatic fisutlas (hole between middle ear and inner ear)
What are central vestibular disorders?
- vascular disorders, ischemia, or hemorrhage to brain stem or cerebellum
- demyelinating disease (ex: MS)
- Tumors
What is being tested with vestibluar function tests (ex: the chair test)?
the VOR
What is being tested with posturography and clinical balance tests?
the VSR
What is the Dix-Hallpik maneuver?
- Turn head to one side and then lay back with approximately 30 degrees of neck extension
- Tests the posterior semicircular canal (most commonly involved in BPPV)
- Should see direction of nystagmus to side that the head is turned if that is the involved ear (ex: head turned right, nystagmus will beat to the right)
What are tests that were designed to assess postural control of individuals with vestibular dysfunction or other balance deficits?
- Fudukas stepping test
- walking with head rotation
- Dynamic Gait Index
- Walking on floor with EC (WOFEC)
- Functional Reach test
What is Fuduka’s stepping test?
50 steps in place, EO then EC. Have them start in box and measure how far they travel
Unilateral vestibular involvement = pt turns to affected side with EC
Bilateral vestibular involvement = pt falls with EC
