Becky Olson-Kellogg, PT DPT GCS CEEAA presented a great course on Vestibular Rehabilitation on May 3rd. Here are some highlights:
1. Benign Paroxysmal Positional Vertigo or BPPV is the most common peripheral vestibular disorder. Because of its anatomic position, the posterior canal is involved 80-90% of the time in BPPV. Treatment using a canalith reposition maneuver can often improve patient symptoms in 1-2 visits.
2. For other vestibular disorders, there are 3 main treatment theories. They can be combined to meet individual patient needs.
a. Adaptation – Long term changes in response to input. The best exercises incorporate head movement and visual input. Just like progressive resistive exercise, the vestibular system needs continuous progressive challenge to improve. If the exercises are easy, the patient won’t get better. Exercises may include head movements, with fixed gaze or with gaze moving from object to object. Consider taping a playing card or list on the wall and having the patient turn their head from one side to the other, focusing and refocusing on the object. Vary head movements (turns, nods, circles), and speed of movement. The patient must focus on the exercise (no distractions), perform 1-2 minutes at a time.
b. Habituation – repetitive exposure to a provocative movement will gradually reduce the adverse reaction. Select 3-4 movements that cause the most increase in symptoms. Perform 10-20 times , 2-3 times per day. Must be performed quickly enough and through sufficient range of motion to produce moderate symptoms. Rest between exercises. Example: begin with static standing, add arm or head movement; change to compliant surface or eyes open/eyes closed to progress.
c. Substitution – when there is a complete bilateral loss of vestibular function, the visual and somatosensory system input needs to be increased to compensate for the loss. Examples: Heel walking or toe walking to increase somatosensory input; use a walker or cane for ambulation; add nightlights to increase visual input at night.
3. If your patient does not have a vestibular disorder, can you use the vestibular treatment strategies with the older adult who has a balance problems? Absolutely! Postural control is maintained through sensory information provided from the visual, vestibular and somatosensory systems. Normal age related changes include diminished visual, vibratory and proprioceptive input so enhancing and strengthening intact systems is a great strategy. And many of our older adult patients to not move around like they used to or perform the same activities or chores. So they may have less opportunity to practice or use their balance skills. Practice improves performance!
You might consider:
- Static standing
o With and without upper extremity support.
o Eyes open/eyes closed
o Narrow base of support
o Tandem stance
o Semi tandem stance
o Single leg standing
- Standing on compliant surfaces
o With upper extremity movement
o Head turns
- Dynamic balance:
o Gait drills
o Heel walking
o Toe walking
o Side stepping
o Obstacle courses
o Box step, dance steps
o Figure 8, start/stop, circles
- Dual Task training/Walking with:
o Head turns
o Talking, counting, naming objects
o Carrying objects
o Path finding