what is a peripheral vestibular hypofunction?
damage to inner ear or nerve that carries info to the brain
what are the core principles of VRT?
adaptation of residual nerve
substitution
habituation
what is the response to a permanent vestibular lesion?
increase response of remaining vestibular system
CNS changes
what are the goals of compensation?
approximate normal gaze stability
reprogramming of eye mvmts and postural responses to mvmts
requires stimuli that challenge the system
requires an error signal
how often should gaze stability exercises for adaptation be performed?
3-5 times per day
1-2 minutes per exercise
what is the error signal?
retinal slip
VOR impairment
how can substitution/compensation be improved?
visual/proprioceptive cues
strengthen weakened systems
what is the recovery rate of each diagnosis?
UVH - 6-8 weeks
BPPV - 1-5 treatments
BVH - 6+ months
CNS - 6 mo - 2 yrs
what are the guidelines for VRT?
1-2 x per week for 4-8 weeks - UVH
1-2 x per week for 12+ weeks - BVH
exercises are main form of treatment
3-5 x/day, 1-2 min each
what are the goals of VRT?
decr symptoms of disequilibrium
decr symptoms of oscillopsia
improve pts functional balance and mobility with ADLs
improve ability to see clearly with head mvmt at various frequencies
improve pts overall physical condition
return to PLOF
what is VOR x1?
target stationary
head moving
what is VOR x2?
head and target moving
what are gaze stability progressions?
incr duration to 2 min
incr velocity
add busy backgrounds
change position
VOR cancellation
2 targets
what does postural stability training need to include?
use of visual, somatosensory, and vestib cues
challenge systems
remove or alter each of the systems
what are some balance progression?
firm to foam surface
eyes open to closed
head motions
stance progressions
alternate positions
what are some examples of oculomotor exercises?
smooth pursuits
sccades
marsden
near/far charts
arrow sheet
shape/color/number
word find puzzles
what are some examples of convergence training?
pencil pushups
lifesaver cards
golf tee and straw
brock string
what are some examples of visual-vestibular conflict training?
laser lights
pattern backgrounds
virtual reality
what are some examples of cervical proprioceptive exercises?
head laser with targets
combine with saccades
eyes closed awareness
what is the goal of habituation?
reduce intensity and duration of symptoms
30 reps
what are cawthorne-cooksey exercises?
5 at home exercises for vertigo
one set at a time
stop and let system settle
full set 3-5 times per day
what is the MSQ?
motion sensitivity quotient
measures 16 quick changes to head or body positions
what is grounding?
have patient sit leaning back into chair and fix eyes on static targt
what is the progression of VRT?
start as early as possible
very brief periods
encourage head and body mvmts
symptoms may incr with exercises
must stress the system
takes time and reps
use metronome
perform at top of limit
mental tasks
add environmental situations
expect improved function in 6 weeks
