Vestibular disorder 1 (1).pptx

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1. Vestibular rehabilitation

2. Vestibular System

3. Introduction The  vestibular  system includes the parts of the inner ear and brain that help control balance and eye movements. If the system is damaged by disease , aging, or injury,  vestibular disorders  can result, and are often associated with one or more of these symptoms, among others: Vertigo and dizziness . Imbalance and spatial disorientation Vision disturbance Hearing changes Cognitive and psychological changes The most commonly diagnosed vestibular disorders include benign paroxysmal positional vertigo (BPPV), labyrinthitis or vestibular neuritis .

4. Role of vestibular system

5. Clinical Manifestation

6. Etiology

7. Vestibulo-ocular Reflex

8. Types of vestibular disorders

9. Is a mechanical problem in inner ear that occur when some of the CaCo3 crystals ( otoconia ) that are normally embedded in gel in the utricle (vestibule) become dislodged and migrate into one or more of 3 fluid filled semicircular canals, where they are not supposed to be. Symptoms related with BPPV Postural instability difficulty concentration Spinning or dizziness Disequilibrium Unsteady gait Sensitivity to head movement Nausea

10. Labyrinthitis or vestibular neuritis are disorder resulting from an infection that inflames the inner ear or the nerves connecting the Inner ear to the brain. The inflammation disrupts the transmission of sensory information from the ear to the brain. Symptoms: Dizziness or vertigo, disequilibrium or imbalance and nausea

11. Meniere’s disease is a disorder of the inner ear that causes episodes in which you feel as if you’re spinning (vertigo), hearing loss, tinnitus, feeling of fullness in ear.

12. Appears to occur in response to an event or underlying condition. For example: It can follow head trauma or ear surgery or inner ear disorder, allergies or systemic disorder (such as diabetes) Symptoms : Tinnitus, hearing loss, dizziness, imbalance, fullness in ear

13. Vestibular and auditory sign and symptoms can result from a dehiscence (opening) in the bone overlying the superior semicircular canal of the inner ear. Symptoms: Vertigo, oscillopsia (the apparent motion of objects that are known to be stationary), evoked by loud noises and coughing, sneezing or straining) Auditory manifestation: Autophony (increased resonance of one’s own voice)

14. Is an uncommon non-cancerous (benign) and usually slow growing tumor that develops on the main nerve leading from your inner ear to your brain. This effects balance and hearing Pressure from acoustic neuroma can cause hearing loss, tinnitus and unsteadiness.

15. A perilymph fistula is an abnormal opening between the air filled middle ear and the fluid filled inner ear. Symptoms: Dizziness, hearing loss, tinnitus, pressure sensitivity, Tullio’s phenomena (sensitivity to loud noises)

16. Refers to drug or chemical related damage to the inner ear, resulting in damage to the organs responsible for hearing and balance. Such damage can lead to temporary or permanent hearing loss, loss of balance.

17. EVAS is a syndromic form of hearing loss caused by enlargement of the vestibular aqueduct in the inner ear. It is one of the most common inner ear deformity which results in hearing loss during childhood Symptoms progress slowly

18. MAV is dizziness that is associated with a migraine headache condition Migraine patients have some accompanying vestibular syndrome involving disruption in their balance, dizziness.

19. Is an imbalance or rocking sensation often both “felt” or “seen” by the sufferer that occurs after exposure to motion (most commonly after a sea cruise or a flight). Although other forms of travel have been known to trigger it. Caused by exposure to an unfamiliar movement Symptoms: Rocking, swaying, disequilibrium, nausea, vomiting

20. Assessment of vestibular function

21. Assessment of vestibular function

22. Musculoskeletal evaluation

23. Vision Vestibuloocular function:   normal eye function requires a combination of smooth and saccadic pursuit eye movements Smooth pursuit: is elicited to closely follow moving targets while the head is stationary, slow tracking movements of eye Saccadic pursuit: primarily directed towards stationary targets, rapid ballistic tracking of eyes

24. Vestibuloocular reflex  (VOR) - Is tested by moving the patient's head vertically and horizontally while the patient fixates vision on a target; normally eyes remain fixed in the target, the presence of saccades is abnormal. Head movements are present all time, the VOR is important for stabilizing vision, subjects whose VOR is impaired find difficult to read and result in oscillopsia . Nystagmus : involuntary, rhythmic oscillations of the eyes, is indicative of disruption of brainstem oculomotor system Types  are horizontal, vertical, rotatory, and mixed

25. VOR suppression test: this test assesses the ability of vestibulocerebellar system to suppress a vestibular signal. It is assessed by asking patients to follow with the head in the same direction an object that rotates; for example the patient looks at their outstretched hands held together while seated in a chair that rotates. 

26. Romberg test Stand-on-one-leg-eyes-closed (SOLEC) test Singleton test   to assess unilateral vestibular deficits; instability when turning toward one side indicates a unilateral lesion in that side Berg Balance Scale Fukuda stepping test   to identify labyrinth deficit  Alignment in sitting/standing Measure base of support in standing Weight shift in sitting/standing