Questions and Answers
What is the purpose of placing a pulse oximeter on the patient's index finger during tilt table therapy?
What is the initial action taken after the patient's heart rate spikes up 10 points during tilt table therapy?
How long should you stim their tongue?
Why is it essential to keep the focal point an arm's length away or use a dot on the ceiling during vestibular rehab?
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What gaze stability do we typically do during tilt table?
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What kind of patients are we usually helping with tilt table?
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What is the goal of tilt table therapy?
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What area do we stim the patient?
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What are the increments that we slowly increase the table at?
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If a patient rejects the tongue stim, what should you do?
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How long should tilt table be performed?
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During tilt table therapy, how often should the set of V3 stimulation and No/No gaze stability be repeated?
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What should be done if the patient expresses symptoms during therapy?
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If the Normatec boots are in the plan but they do not fit the patient properly you should?
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What is absolutely necessary for all tilt table.
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If the patient is unable to do No/No gaze stability looking at your thumb or dot on the ceiling you should?
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What do we use to track info during tilt table?
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What finger should the pulse ox be on?
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How high of a spike in HR indicates an action required?
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Study Notes
Tilt Table Therapy Treatment
- Patient positioning: Lay on top of the tilt table with feet in normatec boots, touching the platform at the end of the table.
- Securing the patient: Use table straps over the patient's hips and torso to ensure safety.
- Monitoring vital signs: Place a pulse oximeter on the patient's index finger to track heart rate during the therapy.
Identifying the Tilt Degree
- Gradually tilt the table upwards while monitoring heart rate.
- Record the tilt degree when heart rate spikes up by 10 points.
- Lower the table by 10 degrees from the spike point and start therapy at this degree.
Tilt Table Therapy Protocol
- Perform 15 seconds of V3 stimulation.
- Follow with a set of vestibular rehab, ensuring the focal point is an arm's length away to prevent convergence.
- Raise the table by 5 degrees and repeat the sequence (V3 stimulation and No/No gaze stability).
- Continue this process until heart rate spikes up by 10 points or the patient expresses discomfort.
- If either occurs, lower the table by 10 degrees and repeat the sequence.
Goal and Duration of Therapy
- Goal: Prevent heart rate from spiking up when mimicking the patient standing up with the tilt table.
- Therapy duration: 10-15 minutes.
- Document the duration of therapy.
Patient Safety
- Monitor patient comfort during therapy.
- Stop therapy immediately if the patient does not feel well.
Tilt Table Therapy Treatment
- Patient positioning: Lay on top of the tilt table with feet in normatec boots, ensuring feet touch the platform at the end of the table.
- Securing the patient: Use table straps to secure both hips and torso.
- Heart rate monitoring: Place a pulse oximeter on the patient's index finger to track heart rate during the therapy.
Initiating Therapy
- Tilt the table slowly upwards until heart rate spikes up 10 points, then record the tilt degree.
- Start therapy at 10 degrees below the recorded tilt degree.
- Initial therapy protocol: 15 seconds of V3 stimulation followed by a set of vestibular rehab (holding the patient's head).
Therapy Progression
- Raise the table 5 degrees and repeat the therapy protocol (V3 stimulation and No/No gaze stability).
- Continue this process until heart rate spikes up 10 points or the patient expresses discomfort.
- If either occurs, go down 10 degrees and repeat the process.
- Goal: Prevent heart rate from spiking up when mimicking the patient standing up with the tilt table.
Therapy Duration and Precautions
- Perform therapy for 10-15 minutes and document the duration.
- Stop therapy immediately if the patient feels unwell during the treatment.
Tilt Table Therapy Treatment
- Patient positioning: Lay on top of the tilt table with feet in normatec boots, ensuring feet touch the platform at the end of the table.
- Securing the patient: Use table straps to secure both hips and torso.
- Heart rate monitoring: Place a pulse oximeter on the patient's index finger to track heart rate during the therapy.
Initiating Therapy
- Tilt the table slowly upwards until heart rate spikes up 10 points, then record the tilt degree.
- Start therapy at 10 degrees below the recorded tilt degree.
- Initial therapy protocol: 15 seconds of V3 stimulation followed by a set of vestibular rehab (holding the patient's head).
Therapy Progression
- Raise the table 5 degrees and repeat the therapy protocol (V3 stimulation and No/No gaze stability).
- Continue this process until heart rate spikes up 10 points or the patient expresses discomfort.
- If either occurs, go down 10 degrees and repeat the process.
- Goal: Prevent heart rate from spiking up when mimicking the patient standing up with the tilt table.
Therapy Duration and Precautions
- Perform therapy for 10-15 minutes and document the duration.
- Stop therapy immediately if the patient feels unwell during the treatment.
Ocular Counter Roll
- Within Normal Limits (WNL), indicating no significant abnormalities in ocular counter roll function.
Spontaneous Nystagmus
- Observed down/right beating nystagmus, suggesting possible central nervous system involvement.
Vertical Saccades
- Left esotropia (eso) noted with upward/downward movements, indicating potential alignment issues when saccading.
Horizontal Saccades
- Findings are within normal limits, indicating proper function in horizontal saccadic movements.
Gaze Stability
- Upward drift in central gaze, with stability in left and right gaze assessments.
Horizontal Pursuits
- Bilateral saccadic intrusions present during horizontal pursuits, indicating possible disruptions in smooth pursuit mechanisms.
Vertical Pursuit
- Saccadic intrusions noted in vertical pursuits, with increased severity during downward movements.
Horizontal Prosaccades
- Increased latency observed when initiating leftward prosaccades, potentially indicating processing delays.
Horizontal Antisaccades
- High error rate of 44%, suggesting difficulties in inhibiting reflexive saccades when instructed to look in the opposite direction.
Vertical Prosaccades
- Increased latency during downward vertical prosaccades, indicating similar processing delays compared to horizontal movements.
Vertical Antisaccades
- Significantly elevated error rate of 78%, reflecting substantial challenges in executing these saccades correctly.
Tilt Table Therapy Procedure
- Patient should lay flat on the tilt table with feet touching the platform at the end for proper positioning.
- Secure both straps over the patient’s hips and torso to ensure safety during the procedure.
- Attach a pulse oximeter to the patient's index finger to monitor heart rate continuously.
- Gradually tilt the table upwards and observe the heart rate; note the degree of tilt when a 10-point spike occurs.
- Lower the tilt by 10 degrees from the spike point to establish a stable starting position for therapy.
Stimulation and Rehabilitation Steps
- Administer 15 seconds of V3 stimulation, followed by vestibular rehabilitation using manual head support.
- Ensure the focus point for rehabilitation is approximately an arm's length away to avoid convergence issues.
- After the initial set, raise the table by 5 degrees and repeat the V3 stimulation along with No/No gaze stability exercises.
- Continue this process until either a 10-point heart rate spike occurs or the patient experiences discomfort, then decrease the tilt by 10 degrees.
Therapy Duration and Monitoring
- Aim for a total therapy duration of 10-15 minutes, recording the exact time spent.
- If the patient reports negative feelings or discomfort during the therapy session, immediately halt the procedure to ensure safety.
Tilt Table Therapy Procedure
- Patient should lay flat on the tilt table with feet touching the platform at the end for proper positioning.
- Secure both straps over the patient’s hips and torso to ensure safety during the procedure.
- Attach a pulse oximeter to the patient's index finger to monitor heart rate continuously.
- Gradually tilt the table upwards and observe the heart rate; note the degree of tilt when a 10-point spike occurs.
- Lower the tilt by 10 degrees from the spike point to establish a stable starting position for therapy.
Stimulation and Rehabilitation Steps
- Administer 15 seconds of V3 stimulation, followed by vestibular rehabilitation using manual head support.
- Ensure the focus point for rehabilitation is approximately an arm's length away to avoid convergence issues.
- After the initial set, raise the table by 5 degrees and repeat the V3 stimulation along with No/No gaze stability exercises.
- Continue this process until either a 10-point heart rate spike occurs or the patient experiences discomfort, then decrease the tilt by 10 degrees.
Therapy Duration and Monitoring
- Aim for a total therapy duration of 10-15 minutes, recording the exact time spent.
- If the patient reports negative feelings or discomfort during the therapy session, immediately halt the procedure to ensure safety.
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Description
This quiz assesses your knowledge of the steps involved in tilt table therapy, including patient preparation and heart rate monitoring. Test your understanding of this therapeutic technique.
