Week 10 Summary Neuro PDF

10.7 OUTCOME MEASURES Progress for vertigo or Dizziness 3 subjective outcome measures 5 objective outcome measures BE ABLE TO SELECT APPROPRIATE outcome measures DONT JUST CHOOSE EVERYTHING ON THE MENU Know which ones are relevant to patient Ya goose… ABC scale- 16 items performing various activitie...

10.7 OUTCOME MEASURES Progress for vertigo or Dizziness 3 subjective outcome measures 5 objective outcome measures BE ABLE TO SELECT APPROPRIATE outcome measures DONT JUST CHOOSE EVERYTHING ON THE MENU Know which ones are relevant to patient Ya goose… ABC scale- 16 items performing various activities 0-100% scale. 67% or less is at risk for falling SUBJECTIVE Dizziness Handicap Inventory 25 item questions Function, Emotion, Physical domains score out of 100 mild 0-30 mod 31-60 60+ SEVERE Visual Vertigo Analog Scale visual vertigo or motion sickness 9 challenging circumstances with a visual line of 10cm How dizzy are you doing certain tasks 4 step square test greater than 12 seconds is indicative of falls in vestib population greater than 10.4 seconds elderly population greater than 15 indicated repeat fallers Timed up and go 11.1 seconds cutoff for vestib 19.5 seconds cutoff for unilateral hypofunction 23.3 bilateral hypofunction Run faster bishhh Berg Balance Static balance Out of 56 pts cutoff 45 Dynamic Gait Index scored out of 24 pts less than 19 is 2.58x more likely to have a fall in past 6 months 3.2 pts detectable change in vestib patients FUNC Gait Index 2 more items 30 pts Backwards gait, and narrow base of narrow support , obstacles 22/30 or less is indicative of falls. 6pts detectable change in vestib patients Sensory Organization Test Modified Clinical Test of Sensory Integration and Balance See pts reliance. 6 conditions VEST, SOMATO, VISION factors DYNAMIC VISUAL ACUITY TEST Vestib ocular reflex Static eye test Read with 20-30 lateral rhead rotation at 2 cycles per second while flexed 30 degrees at neck diff of greater than two lines and acuity between the static and dynamic conditions is indicative of vestib dysfunction 10.8 BPPV Management Know the correct repositioning maneuvers to treat POST and HORZ canalithiasis Know treatment options for other variants Risk factors Remember this chart Which side which canal? Tell the otoconia to go back to your country…..I mean , otoliths 1980 Use of mastoid vibration to shake otoconia Pts should not lay down or move their head for a number of days Wear soft neck collar after treatment -3 > treatments ↓ ↳ 2 treatments I treatment y & & 8 & * & * & Long sit to supine 30 degrees neck ext Watch eyes for nystag Ask patient when symptoms start when goes away how intense is it 1-10 Add another 30 seconds for otoconia to reach most dependent position of semicircular canal before next position Rotate head 90 degrees now while maintaining 30 degrees ext Patient moves to sidelying to that side Head maintains rotation degrees so pt should be looking at ground Sit back up SEMONT Sidelying pts with limited trunk and neck ROM requires rapid body movements pts with post canalith change to horiz canalith o < BBQ ROLL for Horizontal Canalithiasis For Horizontal canalithiasis Pt falls into sidelying towards side away from affected ear After 2 minutes, rotate head downwards, sit up , and rotate neck back to neutral After maneuver- no lying on affected side to prevent reoccurence Ant canalith- increased neck ext to directly target the superior canals. Post canalith- increased neck ext is greater than 30 degrees Kim maneuver Dislodge stuck otoconia- shake see which canal it went to. Rapid headshake Hopping with head tilts Vibration tools PTs shaking persons head Modifications to Epleys Clinicians should reassess patients after one month for resolution or persistence of symptoms Recurrence 50% recurrence in 10 years 80% of those cases coming back in the first year Risk factors 65 yrs or older Female Comorbidities diabetes, Hypertension ,migraine, cerv spondylosis, osteopenia, osteoporosis, head trauma, otitits media, or lots of computers Smoking, alcohol, hyper cholesterolemia, or vitamin D levels are contributing factors 10.9 VR Management Know multidisciplinary roles of health care providers in management of vestib pathology, Detail interventions possible for ocular or visual impairment in vestib pathology. Interdisciplinary Team audiologists, neuro optom, neuro phys, OTs, PTs, physicians in ear nose throat, and speech pathologists FIRST LINE OF DEFENSE Pharmaceutical management lower anxiety and nausea IF BPPV, do the maneuvers because of high treatment success rate IF NOT BPPV , meds can be used to sedate or supress vestib system 3 CLASSES OF DRUGS Antihistamines anticholinergic meclizine, diphenhydramine Benzodiazepines lorazepam, diazepam Antimetics meclizine, zofran NYSTAG suppressing drugs- muscle relaxants, GABA agonists to reduce involuntary eyemovement Restrict salt intake Use of meds- remember use can inhibit neuroplasticity or brains ability to recover SURGICAL management Fistula- bone or membrane graft to close undesired opening Tumor Resection Chemical Ablation- controlled gentamicin application to otoliths to destroy cells Surgical Ablation - compromised structure can be resected Loss of vestib system Neuro Optomtry Management improve the error signals between vestib system, so we can optimize vision CUstom glasses can change the perceived environment to decrease imbalance, vertigo, or visual symptoms Visual therapy- enhance clients function. Orthoptic exercises Pencil pushups Stroop exercise- color and word exercise Optokinetic Stim Cognitive Behavioral Therapy. performed by trained therapists- adjusts underlining behavior associated with avoidance and anxiety Boost mood mental health and decrease isolation Mindfulness techniques, breathing, etc. DIfferentiate between 3 VR principles Understand Evidence 10.10- VR Treatment guidelines PRINCIPLES, Habituation Repeatedly exposing brain to what is causing the vertigo movements of head trunk and body can help provoke vertigo and shouldnt be repeated Learn to ignore the signals, brain will reduce response to stimulus, and symptoms decrease Horizontal head movements, Ball Circles, Head circles, gait with head turns Use Brandt Daroff exercises. Similar to liberatory maneuver, ONE difference, difference is using head rotation along with alternating sideline positions Adaptation brains ability to correct error signals from pathological vest system responding to retinal slip to improve gain so it can match 1 to 1 ratio in healthy population brain has neuroplasticity to respond relies to the need to expose the brain to visual and vestib signals during head movement degree of eyemovement is coordinated with head movement VOR1 or VOR2 are prescribed to induce adaptation Substitution persons ability to maintain balance is founded in the abilty to coordinate vision, somatosensory and vestibular input In absence or inability to supplement vestib input, rehab can involve focus on enhancing TECH systems to prevent calls and minimize vertigo Use Orthoptic training exercises TRAIN cervico ocular reflex to better gaze stability in the presence of vestib deficiencies or complete loss SUBSTITUTION IS NOT ENOUGH ALONE just to help maximize function when there are limitations low 1 Se compared what very -does To VOR I very whit compared low ↳ u to meded is low compared to 3 what otolith and canals do Focus on head control and progress to dynamic movements like locomotion, Adaptation exercises are more effective than substitution and habituation Dosage: perform exercises 3 times a day 12-20 min as a daily home program 1 time a week visits for 2-3weeks for acute symptoms 4-6 weeks if chronic symptoms are present Timing Menieres dont do treatment during attack Concussion early may be detrimental or ineffective Some studies wait 3 months after attack some say 72 hrs afteracute episode Concussion dizziness headaches vertigo and other symptoms immediately pts should have gait balance assessed within 72 hrs DO NOT TREAT or REHAB. 7-10 days AFTER only Progression target size clarity of target pattern Stability Increasehead mvoement speed or amplitude Patient position Increase somatosensory challenges Perform in busy or crowded environment DUAL tasks Drugs can aid, but will affect neurpplasticity Goal is pt should perform independently without meds Hierarchical training possibilities Increase and challenge VOR1 VOR 2 NEGATIVE PROGNOSTIC INDICATORS Convergence VOR training Target moving Towards and away Incremental VOR training Target at different speeds