Taking away vision as a strategy to challenge the patient will leave him with inadequate sensory inputs to maintain balance. Encouraging the patient to continue to use the cane Conclusion The adoption of direct access legislation across the nation and the transition to a doctoring profession places greater responsibility on the physical therapist toward autonomy in practice. Physical therapists must be able to utilize an in-depth knowledge of human systems anatomy and physiology along with scientific evidence to be able to make decisions effectively about when to treat and when to refer. Most importantly, physical therapists need to be able to determine when physical therapy care is the most efficacious management approach. For patients with vestibular disorders, physical therapy care is central to the practice of vestibular rehabilitation. This course provided a foundation for the practicing physical therapist to better understand effective management of common peripheral vestibular disorders. Effective management of vestibular disease starts with a solid understanding of the functional anatomy of the vestibular system as a basis of determining the source of the vestibular dysfunction. Use of the evidence to foster accurate interpretation of examination findings further facilitates differential diagnosis. Physical therapists must also provide evidence that the patient is improving to support our recommendations and to establish Glossary ● Ageotropic : Describes direction of the fast phase of nystagmus away from the ground with the patient in a sidelying position. ● Alexander’s law: Slow phase eye movements of nystagmus are faster when the patient looks toward the direction of the quick phase. ● Ampullae : Widened portion of the semicircular canal at the juncture with the utricle. Contains the sensory hair cells for the semicircular canals. ● Canalithiasis : A type of BPPV where the otoconia are free- floating in the semicircular canal. ● Crista : Sensory structure of the semicircular canals that contain the hair cells that sense angular motion. ● Cupula : Bulbous gelatinous mass that surrounds the hair cells of the crista within the semicircular canal. ● Cupulolithiasis : A type of BPPV where the otoconia are adhered to the cupula. ● Frenzel lenses : Twenty diopter lenses that block visual fixation by the patient, but still allow the examiner to see eye movement responses.
will help provide additional somatosensory inputs through the upper extremity, contributing to enhanced postural control.
medical necessity for skilled care. Much of what was presented in this course emphasized these main areas to guide the clinician’s diagnostic process and use of outcome measures. Treatment of vestibular dysfunction is a targeted approach, based on the specific vestibular pathology and the patient’s individual limitations and functional needs. Exercises specific to vestibular system rehabilitation to promote vestibular adaptation and habituation were presented, with a review of the principles of gait and balance retraining as a basis to facilitate immediate application to clinical practice. Patients with dizziness seek care across multiple disciplines and across the continuum of care settings. The source of their symptoms of dizziness and difficulties with ambulation and balance can be due to peripheral vestibular dysfunction, CNS lesions, or other nonvestibular etiologies. As movement specialists, physical therapists play a pivotal role in the rehabilitation of all of these conditions. The focus of this course was to provide physical therapists with advanced knowledge of this highly specialized system, to expand their practice and to further augment their management of patients with balance dysfunction. ● Geotropic : Describes direction of the fast phase of nystagmus toward the ground with the patient in a sidelying position. ● Hennebert’s sign : Nystagmus indices by pressure change in the external auditory canal. Suggests perilymph fistula or Ménière’s disease. ● Macula : Gelatinous structure in the utricle and saccule that include hair cells that detect linear motion. Otoconia are embedded on top of maculae. ● Saccade : Eye movements used to move quickly or “jump” from one target to another. ● Skew deviation : Vertical misalignment of eyes. Sign of a peripheral or central otolith lesion. ● Smooth pursuit : Smooth eye movement used to track a moving target. ● Tragus : Ear flap directly in front of the external auditory canal. Professional network that supplies additional resources, information, and support. The website contains informative descriptions of vestibular conditions along with general medical and rehabilitative management. Teaching and Learning ● Inner Ear Anatomy: https://commons.wikimedia.org/wiki/File:Anatomy_of_the_ Human_Ear.svg ● Gaze Stabilization Exercises: https://www.dizziness-and-balance.com/treatment/rehab/ gaze%20stab.html ● Head Impulse Test: https://commons.wikimedia.org/wiki/File:The-Video-Head- Impulse-Test-(vHIT)-Detects-Vertical-Semicircular-Canal- Dysfunction-pone.0061488.s004.ogv ● aVOR app, ITunes store https://www.entandaudiologynews.com/reviews/tech- reviews/post/avor-an-educational-tool ● Vestibular Disorders Association (VEDA) https://vestibular.org/
Resources Equipment ● Frenzel lenses: GN Otometrics North America 800-289-2150 Email: sales@gnotometrics.com http://www.otometrics.com ● Interacoustics USA 800-947-6334 ext.4437
Email: md@interacoustics-us.com http://www.interacoustics.com
● Micromedical Technologies 800-334.4154 http://www.micromedical.com Organizations ● Neurology Section, American Physical Therapy Association http://www.neuropt.org ● Timothy Hain, MD, Chicago Dizziness and Hearing Website containing a wealth of information about peripheral and central vestibular disorders for patients and healthcare providers. Many videos on oculomotor testing are available. http://dizziness-and-balance.com/
EliteLearning.com/ Physical-Therapy
Page 137
Powered by FlippingBook