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vestibular therapy

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by

Jonathan Alfonso

on 11 March 2013

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Transcript of vestibular therapy

Vestibular system is internal: cannot be altered
The other two systems are external: can be altered EQUILIBRIUM/BALANCE WHO NEEDS VESTIBULAR AND BALANCE REHABILITATION Anyone with:
BPPV
Degeneration of inner ear
Meniere’s disease
Labyrinthitis
Vestibular neuritis
Long term unresolved inner ear disorders
following surgery for vestibular problems. Goals: Decrease dizziness and visual symptoms.
Improve balance and walking functions.
Increase general activity levels. These symptoms can be debilitating enough that can affect quality of life and cause social deprivation and depression What can be done? Treatment Surgery is not the first line of treatment
possibility of complications (Hearing loss, facial nerve damage)
Surgery is reserved for Meniere’s disease or neuritis that is not responding to medical management
Surgery is rarely needed for BPPV as therapy is very successful. Specific vestibular system problems Vestibular Neuritis
Inflammation of the Vestibular nerve
Ototoxicity
exposure to certain drugs or chemicals (i.e intravenous aminoglycoside antibiotics)
Meniere’s disease
excessive amounts of a fluid called endolymph collecting in the inner ear Specific vestibular system problems These symptoms can result from: peripheral vestibular problem (Inner ear disorders) A tendency to fall and symptoms of dizziness should not be dismissed as unavoidable consequences of aging but may be important signs of disease that might be cured or controlled! Here are the signs: Avoiding uneven surfaces (I.e. grass, sand) Exercises for: Coordinating eye and head movements.
Stimulating the symptoms of dizziness in order to desensitize the vestibular system
Improving balance and walking ability
Improving fitness and endurance Vestibular and Balance Rehab Therapy VBRT is an exercise-based program supervised by a Physical Therapist that specializes in vestibular rehab that can eliminate or significantly reduce symptoms of dizziness and disequilibrium by promoting compensation by the brain for the inner-ear deficits. Symptoms treated in Vestibular Rehabilitation Primary: imbalance & dizziness
Secondary:
Decreased strength
Decreased stamina
Loss of range of motion
Increased tension of the neck and shoulders
Headaches Fortunately most cases of dizziness and imbalance can be treated successfully with Vestibular and Balance Rehab Therapy (VBRT) What can be done? Treatment Medications might be necessary the first 3 days after acute onset of neuritis or labyrinthitis (For vertigo and vomiting)
I.e. Antivert aka meclizine
BPPV does not respond and should not be treated with anti-motion medications such as antihistamines 45% of all dizziness symptoms are caused by problems in the vestibular system. Balance is also dependent on good muscle strength and joint mobility, so having a sedentary life style and arthritis can also compromise your balance A problem in one or more than one of these systems affects your ability to respond to balance challenges cataracts, glaucoma, diabetic retinopathy, and macular degeneration Prone to a variety of diseases Somatosensory System Receptors in the legs or feet that provide external reference from tactile contact with surfaces (ground). Visual System External reference telling the brain about the world outside and about motion of the environment HOW DOES THE BODY MAINTAIN BALANCE? Balance is a complex function that requires that the brain receives accurate and reliable information from 3 sensory systems Vestibular System Tells the brain where the head is in space, its direction of movement and acceleration. Rehabilitation can help! Awareness Prevention One of the leading health concerns for people over the age of 60 is falling Each year, between 20 and 40 percent of the adults over 65, who live at home, fall
consequences of fall can be disastrous:
minor cuts or bruises
brain injury
death Dizziness itself is not a disease it is a symptom that can result from inner ear problems (Vestibular system) or other problems such as cardiovascular, neurological, metabolic, vision etc.
Dizziness and disequilibrium lead to falls age-related loss of vestibular nerve endings can result in severe balance problems without symptoms of dizziness difficulty walking or standing, especially in the dark while on soft or uneven surfaces such as thick carpet, grass or sand One On One Rehab
Dizziness and Balance Center WHAT CAN BE DONE ABOUT THEM? DIZZINESS AND BALANCE ISSUES IN THE OLDER ADULTS

Owner and Director:
Liliana Defiore Dizziness, Vertigo
Balance problems Causing: Head injury
Aging
Viral infections
etc... Can be damaged by: Vestibular system DOES THERAPY SUCCED? Substitution: Disequilibrium Unsteadiness, imbalance or loss of equilibrium often accompanied by spatial disorientation. Vertigo Dizziness A sensation of light-headedness, faintness or unsteadiness UNDERSTANDING FALLS IN OLDER ADULTS Central Nervous
System Visual Vestibular Somatosensory Integrates sensory inputs and generates the appropriate motor response or reaction Touch and position sensors in the feet Inner ear Eyes Diabetic peripheral neuropathy, spinal stenosis, vascular problems. Vestibular Degeneration, infections, and BPPV central disorders (I.e. stroke, tumors, or brain injury) cardiovascular problems (low or high BP) anxiety attacks medication side effects interaction between drugs poor diet or physical activity 2/3 1/3 A Perception of movement; a sense that the world is spinning around you, or your spinning This is “The boss” of the equilibrium system, the only true signal (Because is an internal reference) Visual: Somatosensory: Vestibular System: Touching walls and furniture Trouble with stairs, curbs, or steps. Need to look down to stay balanced Tendency to keep feet apart Imbalance while washing hair with eyes closed Unsteadiness during night-time bathroom trips Adaptation: maneuvers (Epley’s) Liberatory/Reositioning: brain accepts brain compensates QUESTIONS Benign paroxysmal positional vertigo (BPPV)
Caused by debris in inner ear called: Otoconia (crystals or Ear Rocks)
getting out of bed
rolling over in bed
looking up
Labyrinthitis
inflammation of the labyrinth of the inner ear
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