Vestibular RehabilitationPresented by:

Dina Leyden,PT

January 30, 2014

Physical Therapy Evaluation

In order to know which treatment to prescribe to the patient, the PT must perform a thorough evaluation to determine where the symptoms are coming from.

Vestibular Evaluation

• General musculo-skeletal exam

• Sensation• Coordination• Blood pressure

• Oculomotor• Balance

Dizziness is a symptom that can manifest from a vestibular disorder, but can also occur from

• Cardiovascular• Neurological• Metabolic• Visual • Psychological disorders

Benign Paroxysmal Positional Vertigo

• BPPV• Most common vestibular disorder• 2.4% of all people will experience it at

some point in their lifetime• 50% of dizziness in people over age 50

When the head moves

crystals shift

sends a false message

to brain

spinning sensation

BPPV Symptoms

• Spinning/Dizziness• Imbalance• Difficultly

concentrating• Nausea

Common head movements that cause symptoms include:

• looking up• rolling over• getting out of bed.

Test for BPPV

• Hallpike Dix or Roll Test• Observing for nystagmus and patient

report of spinning• Guides therapist to know which canal is

affected and, therefore, which treatment for repositioning to implement

Hallpike-Dix Test for BPPV

Treatment for BPPV

• CRT- canal repositioning treatment• Most common – Epley manuever • Post- treatment instructions• Brandt-Daroff home exercises

Epley Manuever

Brandt- Daroff exercises

Can BPPV come back?

Even with successful treatment, • 1/3 patients have symptoms recur after

1 year.• 50% recur after 5 years

Vestibular Hypofunction

Occurs when one or both vestibular systems are not functioning at full capacity.

Vestibular Hypofunction

• vestibular neuritis• labyrinthitis• Meniere’s disease• Post surgical• Post-concussive syndrome

When the vestibular system malfunctions

unresolved sensory conflict

dizziness,vertigo,dysequilibrium

Test for Vestibular Hypofunction

• Oculomotor exam-coordination of eye and head movement.

• Balance testing with eyes open and closed, firm/foam surface

• Walking tests involving head movement

Treatment for Vestibular Hypofunction

• Gaze stabilization exercises- to coordinate eye and head motion

• Habituation exercises- to become more tolerant of movement

• Standing balance activities• Walking, fitness and endurance when

tolerated

Neck Pain and Stiffness

• Common side effect since movement causes dizziness, therefore patients tend to avoid head movement.

• PT for heat, soft tissue mobilization, joint mobilization, stretching, strengthening, postural re-education.

What Can I Do to Improve My Balance?

•Standing balance exercises•Walking•Yoga•Tai chi

Summary

• Thorough evaluation to determine where deficits are coming from

• Choosing appropriate treatment method• Compliance with home exercise

program• Support