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Vestibular Rehab for Nondizzy Patients: Summary
Eyes Closed • Many patients are visually dependent, so closing eyes will force the brain to use the vestibular and somatosensory systems more to stabilize • Progressions:
Dynamic Movement Tolerance • Find what makes them lose their balance then practice it: ○ Head movements, turning, rocking, moving up/down ○ Use visual targets during complex tasks ○ Gait training: Use elements of the FGA: ■ Head turns, eyes closed, backward, sideways, around/over objects, with tosses General Strengthening and Cardiovascular Treatment Cervicogenic Vestibular Dysfunction: • Manual therapy and moist heat to reduce muscle spasms • May not tolerate dix hallpike for BPPV testing and can use liberatory maneuver instead of the Epley
○ Sitting standing walking ○ With balance challenges/sways Biofeedback Training
• Use visual stimuli to give feedback on a patient’s movements and degree of error when balancing during perturbations • Can include mirrors, manual cuing, computerized dynamic posturography • Can perform in sitting, standing, or walking Snoopy Toss • Playing catch with stuffed animals or other objects to improve patient’s reactions to imbalance perturbations, vestibulospinal reflexes, and gaze stability on a moving target • Progressions: ○ Sitting standing gait unstable surfaces
WORKS CITED
https://qr2.mobi/non-dizzy
CASE STUDY
Eighty-nine-year-old with peripheral neuropathy, deconditioning, and frequent loss of balance with falls that have been increasing over the past year. Noted impaired sensation in both feet/ankles. Assessment:
• MMT: Weakness in the hips; fair core stability • Smooth pursuits fair bilaterally, saccades WFL • No end range nystagmus, head thrust + bilaterally
• Rhomberg EO: 60 sec with minimal sway • Rhomberg EC: 10 sec with high sway • Rhomberg foam EO: 30 sec with moderate sway • Rhomberg foam EC: unable with straight fall backward • FGA: 12/30—shuffling gait, easily fatigued, imbalance with head turns, eyes closed, and backward Interventions: • General strength and conditioning: Bridges, SLR, squats, bike • VOR ×1, wall falls, Snoopy toss, eyes on target during all dynamic movement • Stance on foam, stance with eyes closed • Gait: Forward, backward, sideways • Dynamic stance and gait progressed to eyes closed Results: After 8 weeks: • Rhomberg EC: 60 sec with minimal sway
• Rhomberg foam EO: 60 sec with minimal sway • Rhomberg foam EC: 60 sec with moderate sway • 5/5 MMT for BLE, functional upright core stability • FGA: 20/30 with a cane, DHI 20/100
• Reporting feeling he has returned to his usual ability without restrictions • Gait: Normal stepping pattern with cane for 15 minutes without fatigue
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