102 Gyrostim.pdf

Gyrostim Instructions Turning On ◦ Turn on the switch on the bottom left of the Gyrostim, and turn on computer ◦ Push the green button on the control panel next to the computer ◦ Start the Gyrostim software, click Calibrate and Center chair Turning Off ◦ Go to the main tab, then shut off the p...

Gyrostim Instructions Turning On ◦ Turn on the switch on the bottom left of the Gyrostim, and turn on computer ◦ Push the green button on the control panel next to the computer ◦ Start the Gyrostim software, click Calibrate and Center chair Turning Off ◦ Go to the main tab, then shut off the program and computer ◦ Set up the Gyrostim as if you were about to run it ◦ 5 point harness ◦ Lap belt ◦ Feet belt ◦ Steps are down on ground ◦ Turn the switch off on the bottom left of the Gyrostim Putting Patient In 1. Have all the straps unstrapped, loosened and put to the sides, put steps up 2. Instruct pt to climb in and watch their head 3. Adjust the height of the shoulder strap as needed, put the belts of the 5 point harness in and tighten 4. Put lap belt on and tighten 5. Adjust the height of the footrest so the knees are slightly higher than the thighs 6. Put feet together and against the back rest, put feet belt on 7. Lower the steps down to the ground 8. Close the door Using the Program 1. Create new patient or select existing patient from the “Subject Information” tab 2. To create a new profile, click “Add NEW Subject” 3. Put in the last name, first name, gender, birthday, and dominant hand 4. Use the “RUN Gyrostim” tab for the basic protocols 5. Use “RUN Custom” for custom protocols Nomenclature Custom protocols have a specific nomenclature that must be followed to ensure proper protocol usage Ex. VS LA 5 RPM A1 D1 R1 Velocity Storage Left Anterior Canal Protocol 5 RPM – Rotations per minute/speed, higher is faster A1 – Acceleration of 1 second D1 – Deceleration of 1 second R1 – Rotation of 1 Clinical Thoughts Gyrostim is simply a tool to deliver specific visual vestibular stimulation Before using, determine what you want to accomplish with the therapy 1. Are you trying to deliver OPK stimulation/visual flow? 2. Are you trying to facilitate the eye mm? 3. Are you going to get a better response with a slow phase or fast phase? 4. Are you doing x0 or x1? Determine if the patient can handle the stimulation Basic Principles 1. Make sure patient is fine before and after spins 2. Always check HR, sweatiness of palms, pupil dilation, and other signs of fatigue in between reps. Only spin if the patient is not showing signs of fatigue 3. Take advantage of time in between reps – you have facilitation of the presynaptic pools that make other exercises more effective 4. Complex movements, hypertropia treatment, divergence, specific eye movements 5. Can check balance on the airex in between sets to make sure you are doing the correct thing 6. Start w/ 1 spin, then work your way up to 2 and 3 spin protocols if they can handle it. Then increase speed and go back down in reps. 7. Spend 10-20 minutes for patients and reserve your spot on the sign in sheet Basic Protocol Basic protocol is great for people who haver ventral striatal gating issues ◦ Highly emotional, FND, athletes who chase dopamine ◦ It combines head-eye integration and multiple VOR cancellations Information ◦ Purpose: General visual/vestibular stimulation, increasing reaction time, cognition ◦ Position: Limit amount of head movement if possible ◦ Tips: Start at 2 non invert for anxious people, then increase to 5 w/ invert. After can jump to 8+, doing 30 sec at a time. Get them to be excited to beat their score, can add dual tasking such as naming many words starting with a letter, or math problems Sinusoidal Isolate visual/vestibular stimulation, limited C-spine involvement thus preventing sensory mismatches With cross axis adaptation horizontals can help verticals and vice versa Yaw ◦ Purpose: Helps improve gaze stability, SWJ, ocular impersistence – horizontal eye movement pathology ◦ Position: Eyes fixated on target directly in front, head still ◦ Tips: Use as a warm up, or as light stimulation in between sets Pitch ◦ Purpose: Helps improve gaze stability, SWJ, ocular impersistence – vertical eye movement pathology ◦ Position: Eyes fixated on target directly in front, head still ◦ Tips: Use as a warm up, or as light stimulation in between sets RALP/LARP Canal Planes Most patients will have one canal that they need more than the other ◦ The protocol will have a specific canal designated, choose the canal that you want to focus on more ◦ Have the patient look at the dot in the Gyrostim as the patient will be spinning 360 degrees Velocity Storage Gyrostim will spin at a constant velocity with no acceleration/deceleration for most of the test Anterior canal VS are in direction of paired eye movements ◦ R anterior= forward pitch L yaw ◦ L anterior= forward pitch R yaw All canals ◦ Purpose: VS stimulation to a canal, weak eye mm, gentle stimulation to central integrators in brainstem ◦ Position: Eyes fixated on dot in chair for gentle stimulation, eyes looking forward for optic flow/VS ◦ Tips: Start w/ fixation at a slow speed, if pt can tolerate stimulation try without fixation. Then slowly progress to faster speeds without fixation, going back to fixation or slower speeds if pt has symptoms VOR Gyrostim will spin at an acceleration/deceleration WITHOUT any constant velocity Anterior canal VS are in direction of paired head movement ◦ R anterior= forward pitch R yaw ◦ L anterior= forward pitch L yaw All canals ◦ Purpose: VOR to a canal, increase gain VHIT ◦ Position: Eyes fixated on dot in chair for gentle stimulation, eyes looking forward for VOR ◦ Tips: Start w/ fixation at a slow speed, if pt can tolerate stimulation try without fixation. Then slowly progress to faster speeds without fixation, going back to fixation or slower speeds if pt has symptoms End Goals Our goal is to help patients become fully functional in real-life situations. Slow movements and gentle spins won’t prepare them for the real world. If the patient experiences symptoms when turning their head, you need to train the VOR/VS to be working at faster speeds if they can tolerate it asymptomatically The goal is to go up to 15 RPM on the Gyrostim for all protocols