VestibularInserviceLabPortion-Participant
3
Vestibular Inservice Lab Portion Nathan Dugan PT, DPT Kalispell Regional Medical Center January 20, 2016 Oculomotor Testing 1. Convergence 2. Smooth pursuit 3. Saccades Vestibular Testing 1. Spontaneous and GazeEvoked Nystagmus (combine with smooth pursuit) 2. Head Impulse Test a. Head in 30 degrees of cervical flexion b. Small amplitude (510 degrees), high velocity thrust c. Can be performed to near or far target (far target when convergence is impaired) 3. Horizontal and Vertical HeadShaking Nystagmus a. 20 rotations, hold head still afterwards BPPV Tests 1. DixHallpike Maneuver a. 45 degrees rotation, 30 degrees extension; test asymptomatic side first 2. Roll Test a. 20 degrees of cervical flexion, performed in supine
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Transcript of VestibularInserviceLabPortion-Participant
Vestibular Inservice Lab Portion Nathan Dugan PT, DPT
Kalispell Regional Medical Center January 20, 2016
Oculomotor Testing
1. Convergence 2. Smooth pursuit 3. Saccades
Vestibular Testing
1. Spontaneous and GazeEvoked Nystagmus (combine with smooth pursuit) 2. Head Impulse Test
a. Head in 30 degrees of cervical flexion b. Small amplitude (510 degrees), high velocity thrust c. Can be performed to near or far target (far target when convergence is impaired)
3. Horizontal and Vertical HeadShaking Nystagmus a. 20 rotations, hold head still afterwards
BPPV Tests
1. DixHallpike Maneuver a. 45 degrees rotation, 30 degrees extension; test asymptomatic side first
2. Roll Test
a. 20 degrees of cervical flexion, performed in supine
BPPV Treatments 1. Canalith Repositioning Treatment (CRT) for posterior/anterior canalithiasis
2. BarBQue Roll (normal speed/quick) for horizontal canal canalithiasis/cupulolithiasis
3. Liberatory/Semont Maneuver for anterior/posterior canal cupulolithiasis
a. Posterior head rotated 45 degrees towards UNAFFECTED ear, moved onto AFFECTED side (treating left posterior canal in image)
b. Anterior head rotated 45 degrees AFFECTED ear, moved onto AFFECTED side 4. Deep HeadHanging Maneuver for anterior canal canalithiasis
5. Appiani Maneuver for horizontal canal canalithiasis
a. Lie on UNAFFECTED side, quickly 45 degrees down after 2min
6. Casani Maneuver for horizontal canal cupulolithiasis
a. Lie on AFFECTED side, immediately turn 45 degrees down 7. Forced prolonged positioning for horizontal canal
a. Patient lies on AFFECTED side for 20 seconds, then slowly rolls to the UNAFFECTED side, remaining in this position all night
8. BrandtDaroff Habituation Exercises a. Turn head 45 degree to UNAFFECTED side, rapidly move into sidelying toward
AFFECTED side b. Once vertigo subsides, patient sits up c. After 30 seconds, head turned to opposite side and patient lies on opposite side
for 30 seconds d. Repeat until vertigo diminishes e. Repeat every 3 hours until 2 consecutive days without vertigo
