Vestibular rehabilitation

Provides information concerning gravity, rotation and acceleration
Serves as a reference for the somatosensory & visual systems
Contributes to integration of arousal, conscious awareness of the body via connections with vestibular cortex, thalamus and reticular formation

1. Dr. Maheshwari Harishchandre
M.P.Th (Neurosciences)
Asst. Professor
DVVPF College of Physiotherapy,
Ahmednagar

2. •At the end of lecture learner should be
able to- knows vestibular structure &
function
•Differentiate between peripheral and
central vestibular pathology
•Vestibular rehabilitation in patients.
Lecture Objectives
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Vestibular rehab.

3. •Provides information concerning gravity,
rotation and acceleration
•Serves as a reference for the
somatosensory & visual systems
•Contributes to integration of arousal,
conscious awareness of the body via
connections with vestibular cortex,
thalamus and reticular formation
Vestibular System Function
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5. Respond to:
Linear head motion on acceleration
Static tilt
Help with balance, orientation & sound
detection.
Otolith Function
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6. Tonic firing rate
Vestibular Ocular Reflex
Push-pull mechanism
Inhibitory cutoff
Principles of the
Vestibular System
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7. Primary vestibular afferents of the healthy
vestibular system have a resting firing rate
i.e. 70 to 100spikes/s.
VESTIBULO- OCULAR REFLEX
Maintaining stability of an image on the
fovea of the retina during rapid head
movements.
Tonic firing rate
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8. Head moves in one direction, the eyes move
in the opposite direction with equal velocity.
This relationship of eye velocity to head
velocity is expressed as the gain of vest.
System.
VOR Phase is a 2
nd
useful measure of the
vest. System & represents timing
relationship for eye & head position
Tonic firing rate
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9. Head is turned to the right, the right
horizontal SCC will have an increased firing
rate while the left horizontal SCC has a
decreased firing rate. This is called push –
pull mechanism.
Push-pull mechanism
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10. Vestibular nerve and vestibular nuclei
have a normal resting firing rate (70-
100 cycles/sec)
Baseline firing rate present without
head movement
Tonic firing is equal in both sides; if not,
a sense of motion is felt e.g., vertigo,
tilt, impulsion, spinning
Tonic Firing Rate
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11. Excitation and inhibition of the
vestibular system can then occur from
stimulation of the hair cells
Spontaneous recovery with light
Tonic Firing Rate
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12. Inhibitory cutoff : -
- During angular head rotations ipsilateral
vestibular afferents can be excited upto
400 spikes/s.
- A concomitant hyperpolarization of the
opposite labyrinth also occurs.
- however, the hyperpolarisation of the
hair cells in the opposite labyrinth can only
decrease the firing rate to zero, at which
point the inhibition is cutoff.
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13. •Vertigo
•Lightheadedness
•Dysequlibrium
•Oscillopsia
Terms
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14. An asymmetrical firing of the two vestibular
systems
Gives an illusion of spinning, movement
Indicative of any one or combination of
causes (acute UVH, BPPV, brainstem
lesion, vascular hypotension…)
Vertigo
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16. Peripheral Central
Nausea severe moderate
Imbalance mild severe
Hearing Loss common rare
Oscillopsia mild severe
Neurologic Symptomsrare common
Differentiation Between
Peripheral & Central
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17. 1.Nystagmus
2.Head thrust test
3.Head – shaking Induced nystagmus
4.Positional testing (BPPV)
5.Dynamic visual acuty test
Vestibular Function
Tests
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18. Gold standard used to check for the
presence of benign paroxysmal positional
vertigo (BPPV)
Nystagmus induced by this test is an
objective measurement from which we can
determine SSC dysfunction and assess a
response to treatment
Hallpike-Dix Maneuver
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19. Signs & symptoms
•sudden, severe attacks of vertigo
precipitated by certain head positions &
movements
•e.g., rolling over, neck extension, bending
forward
•lightheadedness; nausea
•anxiety
Benign Paroxysmal
Positional Vertigo (BPPV)
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20. 5 criteria crucial in diagnosis (Hallpike-Dix
Test):
torsional/linear-rotary nystagmus;
reproduced by provocative positioning
with affected ear down
nystagmus of 1-5 sec.
nystagmus of brief duration (5-30 sec.)
reversal of nystagmus direction on
returning to upright position
response diminishes with repetition of
maneuver (fatigability)
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21. •Balance & gait deficits
•Head movement-induced dizziness
•Head movement-induced visual blurring
(oscillopsia)
•LE dressing difficulty
•Driving deficits
•Disability related to work & social activities
Problems Experienced with
Vestibular Loss
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22. diminish dizziness & vertigo
enhance gaze stabilization
enhance postural stability in static &
dynamic situations
Increase overall functional activities
control of exacerbations
Vestibular Exercise Program
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23. Postural exercises
Habituation exercises
Cowthron & cooksey exercises
Gaze stability exercise
Gait training
Balance exercises
Physiotherapy management
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25. Qee
Physiotherapy
management
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27. Gaze stability
exercise
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29. •Vestibular system Anatomy
•Function
•Principles
•Assessment
•Tests
•Physiotherapy treatment
SUMMARY
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