Vestibular Rehabilitation

by Herdman, Susan J.

• ISBN13: 9780803604445
• ISBN10: 0803604440
• Format: Hardcover
• Copyright: 1999-11-01
• Publisher: F a Davis Co

Summary

Univ. of Miami, Coral Gables, FL. Addresses the need for vestibular system analysis and treatment for older adults. Reviews factors contributing to imbalance in the elderly and how these factors may be remedied. Checklists, assessment tools, and seven new chapters are included. Previous edition: c1994. For therapists. DNLM: Vestibular Diseases.

Table of Contents

SECTION I: Fundamentals	1	(102)
Chapter 1 Anatomy and Physiology of the Normal Vestibular System	3	(22)
Timothy C. Hain, MD
Tanya S. Ramaswamy, MD
Michael A. Hillman, MD
Purpose of the Vestibular System	3	(2)
The Peripheral Sensory Apparatus	5	(3)
Bony Labyrinth	5	(1)
Membranous Labyrinth	6	(1)
Hair Cells	6	(1)
Vascular Supply	7	(1)
Physiology of the Periphery	8	(5)
Semicircular Canals	8	(2)
Otoliths	10	(2)
The Vestibular Nerve	12	(1)
Central Processing of Vestibular Input	13	(3)
Vestibular Nucleus	13	(1)
Vascular Supply	13	(1)
Cerebellum	14	(1)
Neural Integrator	15	(1)
Motor Output of the Vestibular System Neurons	16	(1)
Output for the Vestibulo-Ocular Reflex	16	(1)
Output for the Vestibulospinal Reflex	16	(1)
Vestibular Reflexes	17	(2)
The Vestibulo-Ocular Reflex	18	(1)
The Vestibulospinal Reflex	18	(1)
The Vestibulocollic Reflex	18	(1)
Cervical Reflexes	19	(1)
The Cervico-Ocular Reflex	19	(1)
The Cervicospinal Reflex	19	(1)
The Cervicocollic Reflex	19	(1)
Visual Reflexes	19	(1)
Somatosensory Reflexes	20	(1)
Higher-Level Problems in Vestibular Processing	20	(3)
Velocity Storage	20	(1)
Compensation for Overload	21	(1)
Sensor Ambiguity	21	(1)
Motion Sickness	22	(1)
Repair	22	(1)
Summary	23	(2)
Chapter 2 Role of the Vestibular System in Postural Control	25	(27)
Fay B. Horak, PT, PhD
Charlotte Shupert, PhD
Sensing and Perceiving Position and Motion	26	(3)
Orienting the Body to Vertical	29	(7)
Postural Alignment	29	(3)
Selecting Sensory Information	32	(4)
Controlling Center of Body Mass	36	(9)
Role in Static Positions	37	(2)
Role in Automatic Postural Responses	39	(6)
Stabilizing the Head	45	(1)
Summary	46	(6)
Chapter 3 Postural Abnormalities in Vestibular Disorders	52	(25)
Emily A. Keshner, PT, EdD
Examining the Vestibulospinal System	53	(6)
Advantages and Limitations of Clinical Tests	53	(1)
Dynamic Posturography	54	(3)
Tests of Quiet Stance	57	(1)
Stabilometry	58	(1)
Tiltboards	58	(1)
Stepping Tests	58	(1)
Postural Reactions in Peripheral Vestibular Disorders	59	(4)
Deficient Labyrinthine Inputs	59	(1)
Indicators of Vestibulospinal Deficiency	60	(3)
Indications of Vestibulospinal Distortion	63	(1)
Postural Reactions in Central Vestibular Lesions	63	(1)
Postural Dysfunction with Pathology of Other Sensory-Motor Centers	64	(2)
Mechanisms for Recovery of Postural Stability	66	(5)
Sensory Substitution	66	(3)
Compensatory Processes	69	(2)
Summary	71	(6)
Chapter 4 Vestibular Adaptation	77	(14)
David S. Zee, MD
Recalibration, Substitution, and Alternative Strategies	77	(7)
Loss of Unilateral Labyrinthine Function	78	(4)
Loss of Bilateral Labyrinthine Function	82	(2)
Studies of Vestibulo-Ocular Reflex Adaptation in Normal Subjects	84	(3)
Imagination and Effort of Spatial Localization in Vestibular Adaptation	85	(1)
Context Specificity	86	(1)
Neurophysiologic Substrate of Vestibulo-Ocular Reflex Adaptation	87	(1)
Summary	87	(4)
Chapter 5 Vestibular System Disorders	91	(12)
Michael Fetter, MD
Benign Paroxysmal Positional Vertigo	91	(2)
Vestibular Neuritis	93	(1)
Meniere's Disease and Endolymphatic Hydrops	94	(3)
Perilymphatic Fistula	97	(1)
Vestibular Paroxysmia (Disabling Positional Vertigo)	98	(1)
Bilateral Vestibular Disorders	99	(2)
Summary	101	(2)
SECTION II: Medical Assessment	103	(132)
Chapter 6 Quantitative Vestibular Function Tests and the Clinical Examination	105	(67)
Vicente Honrubia, MD, DMSc
Clinical Evaluation of Vestibular Patients	106	(22)
Dizziness and Vertigo	106	(2)
Nystagmus	108	(4)
Recording Pathological Nystagmus	112	(3)
Characteristics of Different Types of Pathological Nystagmus	115	(13)
Quantitative Vestibular Ocular Tests	128	(44)
Tests of Visual-Ocular Control	130	(1)
Saccadic Eye Movements	131	(3)
Smooth Pursuit	134	(1)
Optokinetic Nystagmus	135	(4)
Test of Vestibulo-Ocular Reflex Function	139	(20)
Tests of Visual Vestibular Interaction	159	(6)
Subjective Vestibular Tests	165	(7)
Chapter 7 Clinical Changes in Vestibular Function with Time after Unilateral Vestibular Loss	172	(23)
Ian S. Curthoys, PhD
G. Michael Halmagyi, MD
Consequences of Unilateral Vestibular Loss in Humans	172	(12)
Static Sensory Components	173	(1)
Dynamic Sensory Components	173	(5)
Static Motor Components	178	(3)
Dynamic Motor Components	181	(3)
Summary of Changes in Vestibular Function with Time after Lesions	184	(1)
Factors Influencing the Restoration of Static and Dynamic Equilibrium	184	(3)
Visual Inputs	185	(1)
Vestibular Inputs	185	(1)
Proprioceptive Inputs	185	(1)
Medications	185	(1)
Lesions	186	(1)
Chronic Vestibular Insufficiency Following Unilateral Vestibular Loss	186	(1)
Neural Activity in the Vestibular Nuclei during Vestibular Compensation	187	(4)
Normal Medial Vestibular Nucleus Activity	188	(1)
Ipsilesional Medial Vestibular Nucleus Activity	188	(1)
Contralesional Medial Vestibular Nucleus Activity	188	(2)
Normal Lateral Vestibular Nucleus Activity	190	(1)
Ipsilesional Lateral Vestibular Nucleus Activity	190	(1)
Contralesional Lateral Vestibular Nucleus Activity	190	(1)
Summary	191	(4)
Chapter 8 Otolith Function Tests	195	(20)
G. Michael Halmagyi, MD
Ian S. Curthoys, PhD
Otolith Structure	196	(2)
Normal Otolith Function	198	(1)
Primary Otolithic Afferents	198	(2)
Central Projections	199	(1)
Function of Otolithic Input	199	(1)
The Subjective Visual Horizontal (or Vertical): A Test of Utricular Function	200	(4)
Physiological Background	200	(2)
Central Vestibular Lesions and Settings of the Subjective Visual Vertical	202	(2)
Vestibular-Evoked Myogenic Potentials: A Test of Saccular Function	204	(4)
Physiological Background	204	(2)
Method	206	(1)
Clinical Applications	206	(2)
Case Study	208	(5)
Summary	213	(2)
Chapter 9 Audiological Assessment and Management	215	(20)
M. Cara Erskine, MEd
Hiroshi Shimizu, MD
Audiological Assessment	215	(10)
Measurement of Behavioral Hearing Threshold	215	(2)
Types of Hearing Loss	217	(1)
Speech Audiometry	218	(1)
Acoustic Immittance Measurements	219	(1)
Auditory Brainstem Response Testing	220	(5)
Otoacoustic Emission	225	(1)
Management of Hearing Impairment	225	(6)
Hearing Aids	226	(1)
Aural Rehabilitation	227	(1)
Cochlear Implants	228	(2)
Auditory Training	230	(1)
Summary	231	(4)
SECTION III: Medical Management	235	(96)
Chapter 10 Pharmacological and Optical Methods of Treating Vestibular Disorders and Nystagmus	237	(14)
R. John Leigh, MD
Vertigo	239	(3)
Pathophysiology	239	(1)
Neuropharmacology of Vertigo and Nystagmus	239	(1)
Treatment	240	(2)
Oscillopsia	242	(2)
Pathogenesis	242	(2)
Treatment	244	(1)
Nystagmus and Its Visual Consequences	244	(4)
Pathogenesis	244	(1)
Treatments	244	(4)
Summary	248	(3)
Chapter 11 Surgical Management of Vestibular Disorders	251	(13)
Douglas E. Mattox, MD
Acoustic Neuromas (Vestibular Schwannoma)	251	(5)
Middle Cranial Fossa	252	(1)
Translabyrinthine Approach	253	(1)
Suboccipital Craniectomy	254	(2)
Meniere's Disease	256	(3)
Post-Traumatic Vertigo	259	(1)
Benign Paroxysmal Positional Vertigo	259	(1)
Perilymph Fistula	260	(1)
Vascular Loops	261	(1)
Summary	262	(2)
Chapter 12 Assessment and Management of Central Vestibular Disorders	264	(34)
Thomas Brandt, MD, FRCP
Marianne Dietrich, MD
Clinical Classification of Central Vestibular Disorders	265	(4)
Vestibular Disorders in (Frontal) Roll Plane	269	(9)
Etiology	274	(1)
Natural Course and Management	275	(1)
Thalamic and Cortical Astasia Associated with Subjective Visual Vertical Tilts	276	(1)
Torsional Nystagmus	277	(1)
Vestibular Disorders in (Sagittal) Pitch Plane	278	(6)
Upbeat Nystagmus (Vestibular Upbeat Syndrome)	281	(3)
Vestibular Disorders in (Horizontal) Yaw Plane	284	(1)
Vestibular Cortex: Locations, Functions, and Disorders	285	(7)
The Parietoinsular Vestibular Cortex	286	(1)
Multimodal Sensorimotor Vestibular Cortex Function and Dysfunction	286	(1)
Spatial Hemineglect, a Cortical Vestibular Syndrome?	287	(1)
Paroxysmal Room-Tilt Illusion	288	(1)
Vestibular Epilepsy	288	(1)
Paroxysmal Central Vertigo	289	(3)
Summary	292	(6)
Chapter 13 Diagnosis and Management of Neuro-Otological Disorders Due to Migraine	298	(18)
Ronald J. Tusa, MD, PhD
Incidence	298	(1)
Classification and Criteria for Diagnosis	299	(2)
Migraine without Aura	300	(1)
Migraine with Aura	300	(1)
Childhood Periodic Syndromes	301	(1)
Migrainous Infarction	301	(1)
Neuro-Otological Syndromes	301	(3)
Disorders Due to Migraine	302	(1)
Disorders Associated with Migraine	303	(1)
Pathophysiology	304	(1)
Neurochemical Mechanism	304	(1)
Genetics	304	(1)
Management	305	(5)
Reduction of Risk Factors	305	(3)
Medications	308	(2)
Case Examples	310	(3)
Summary	313	(1)
Patient Information	313	(3)
Chapter 14 Psychological Problems and the Dizzy Patient	316	(15)
Ronald J. Tusa, MD, PhD
Prevalence	316	(2)
Psychological Problems in Patients with Dizziness	316	(1)
Dizziness in Patients with Psychological Disorders	317	(1)
Disability	318	(1)
Psychological Disorders	318	(2)
Anxiety	318	(1)
Somatoform Disorders	319	(1)
Factitious Disorders	319	(1)
Malingering	320	(1)
Phobic Postural Vertigo	320	(1)
Mal de Debarquement Syndrome	320	(1)
Assessment	320	(4)
History	320	(3)
Examinations for Psychogenic Stance and Gait Disorders	323	(1)
Management	324	(1)
Longitudinal Studies	325	(1)
Case Studies	325	(3)
Summary	328	(3)
SECTION IV: Rehabilitation Assessment and Management	331	(242)
Chapter 15 Physical Therapy Assessment of Vestibular Hypofunction	333	(40)
Susan L. Whitney, PT, ATC, PhD
Susan J. Herdman, PT, PhD
Functional Deficits	333	(3)
Vestibulo-Ocular Dysfunction	334	(1)
Motion-Induced Disequilibrium	334	(1)
Postural Instability	335	(1)
Physical Deconditioning	335	(1)
Physical Therapy Evaluation	336	(23)
History	336	(3)
Clinical Examination	339	(7)
Balance Assessment	346	(7)
Gait Evaluation	353	(6)
Transition from Assessment to Treatment	359	(1)
Summary	360	(13)
Chapter 16 Disability in Vestibular Disorders	373	(14)
Helen S. Cohen, EdD, OTR, FAOTA
Taxonomies of Disablement	374	(3)
World Health Organization System	374	(2)
National Institutes of Health Taxonomy	376	(1)
Functional Limitations and Disability in Activities of Daily Living	377	(7)
Assessments	377	(1)
Self-Care Tasks	378	(1)
Instrumental Tasks	379	(1)
Mobility Skills	379	(1)
Psychosocial Consequences	380	(1)
Diagnosis-Specific Problems	381	(3)
Effects of Vestibular Rehabilitation	384	(1)
Summary	384	(3)
Chapter 17 Treatment of Vestibular Hypofunction	387	(37)
Susan J. Herdman, PT, PhD
Susan L. Whitney, PT, ATC, PhD
Mechanisms of Recovery	387	(5)
Cellular Recovery	387	(1)
Spontaneous Recovery	388	(1)
Vestibular Adaptation	388	(1)
Substitution	389	(2)
Habituation	391	(1)
Evidence that Exercise Facilitates Recovery	392	(1)
Predictors of Outcome	393	(1)
Goals of Treatment	394	(1)
Is Recovery Maintained after the Exercises Are Stopped?	394	(1)
Treatment Approaches	394	(6)
Adaptation	394	(3)
Substitution	397	(1)
Cawthorne-Cooksey Exercises	397	(2)
Habituation Exercises	399	(1)
Expectations for Recovery	400	(1)
Treatment	401	(1)
General Considerations	401	(1)
Problem-Oriented Approach	402	(9)
Problem: Visual Blurring and Dizziness When Performing Tasks that Require Visual Tracking or Head Stabilization	403	(2)
Problem: Exacerbation of Symptoms	405	(1)
Problem: Static and Dynamic Postural Instability	405	(4)
Progression of Balance and Gait Exercises	409	(1)
Problem: Physical Deconditioning	409	(2)
Problem: Return to Driving	411	(1)
Summary	411	(1)
Case Studies	411	(13)
Chapter 18 Assessment and Treatment of Complete Vestibular Loss	424	(27)
Susan J. Herdman, PT, PhD
Richard A. Clendaniel, PT, PhD
Primary Complaints	424	(2)
Balance	424	(1)
Oscillopsia	425	(1)
Sense of Disequilibrium or Dizziness	425	(1)
Physical Deconditioning	425	(1)
Assessment	426	(5)
History	427	(1)
Subjective Complaints	428	(1)
Vestibular Function	428	(1)
Visual System	428	(1)
Somatosensory System	429	(1)
Balance and Gait	429	(2)
Mechanisms of Recovery	431	(3)
Gaze Stability	432	(1)
Postural Stability	433	(1)
Compensatory Strategies	433	(1)
Evidence that Exercise Facilitates Recovery	434	(1)
Treatment	434	(6)
Progression of Exercises	438	(1)
Guidelines to Treatment and Prognosis	438	(2)
Summary	440	(1)
Case Studies	440	(11)
Chapter 19 Assessment and Treatment of Patients with Benign Paroxysmal Positional Vertigo	451	(25)
Susan J. Herdman, PT, PhD
Ronald J. Tusa, MD, PhD
Characteristics and History	451	(8)
Mechanism	452	(2)
Canal Involvement	454	(1)
Diagnosis	454	(5)
Treatment	459	(11)
Canalith Repositioning Treatment: Posterior and Anterior Canal Canalithiasis	459	(3)
Canalith Repositioning Treatment: Horizontal Canal Canalithiasis	462	(1)
Liberatory Maneuver: Posterior Canal	463	(2)
Brandt-Daroff Habituation Exercises: Posterior Canal Cupulolithiasis	465	(1)
Treatment Guidelines	466	(2)
Postural Disturbances	468	(1)
Management	469	(1)
Conclusion	470	(1)
Case Studies	471	(5)
Chapter 20 Vestibular Rehabilitation of the Patient with Traumatic Brain Injury	476	(18)
Anne Shumway-Cook, PT, PhD
Vestibular Pathology	477	(1)
Concussion	477	(1)
Fractures	477	(1)
Intracranial Pressure and Hemorrhagic Lesions	478	(1)
Central Vestibular Lesions	478	(1)
Vestibular Rehabilitation	478	(11)
Vertigo	479	(1)
Eye-Head Coordination	480	(1)
Postural Control Underlying Stability	481	(7)
Time Course for Recovery	488	(1)
Case Study	489	(1)
Summary	490	(4)
Chapter 21 Cervical Vertigo	494	(16)
Richard A. Clendaniel, PT, PhD
Posterior Cervical Sympathetic Syndrome	494	(1)
Vertebrobasilar Insufficiency	495	(1)
Altered Proprioceptive Signals	495	(7)
Anatomy and Physiology	496	(1)
Findings Following Cervical Spine Lesions	497	(5)
Examination and Treatment	502	(3)
Conclusion	505	(1)
Case Study	505	(5)
Chapter 22 Management of the Elderly Person with Vestibular Dysfunction	510	(24)
Susan L. Whitney, PT, ATC, PhD
Vestibular Function	510	(2)
Semicircular Canal Function	511	(1)
Utricular and Saccular Function	511	(1)
Vestibular Function Tests	512	(1)
Visual Deficits	512	(3)
Somatosensory Changes	515	(1)
Musculoskeletal Deficits	516	(1)
Postural Hypotension	516	(1)
Cerebellar Atrophy	516	(1)
Fear of Falling	516	(1)
Attention	517	(1)
Depression	517	(1)
Risk of Falling in Older Adults with Vestibular Disorders	517	(5)
Questionnaires for Balance Assessment	522	(3)
Dizziness Assessment	525	(1)
Typical Balance Tests	525	(1)
Home Assessment	526	(1)
Length of Treatment	526	(1)
What To Do Once the Risk Factor Has Been Identified	526	(1)
Case Studies	527	(4)
Summary	531	(3)
Chapter 23 Treatment of Patients with Nonvestibular Dizziness and Disequilibrium	534	(11)
Neil Shepard, PhD
Annamarie Asher, PT
Patient Identification	535	(1)
Ruling Out a Vestibular Problem	535	(1)
Nonvestibular Dizziness	535	(1)
Treatment Program for Patients with Nonvestibular Dizziness	536	(1)
Outcome Measures	537	(1)
Diagnostic Categories and Results	538	(5)
Mal de Debarquement	538	(2)
Migraine	540	(1)
Disequilibrium Associated with Aging	540	(1)
All Test Findings Normal	541	(1)
Primary Anxiety and Panic	541	(1)
Central Nervous System Lesions	542	(1)
Summary	543	(2)
Chapter 24 Evaluation and Treatment of Vestibular and Postural Control Deficits in Children	545	(21)
Rose Marie Rine, PT, PhD
Incidence of Vestibular Deficits in Children	546	(3)
Development of Postural and Oculomotor Control as They Relate to Vestibular System Function	549	(2)
Evaluation	551	(7)
Treatment	558	(1)
Peripheral Disorders	558	(1)
Central Vestibular and Postural Control Deficits	558	(1)
Case Studies	559	(3)
Summary	562	(4)
Chapter 25 Physical Therapy Diagnosis for Vestibular Disorders	566	(7)
Susan J. Herdman, PT, PhD
History	566	(1)
Clinical Examination	567	(1)
Diagnostic Flowchart	567	(2)
Identification of Modifiers	569	(1)
Summary	570	(3)
Index	573