Chapter 20: Examination and Treatment of Vestibular System Disorders

For the Instructor Guide and Worksheet Key please contact user services at userservices@mheducation.com

Click here to view the Neurologic Lab Manual Video Balance Testing.

OUTLINE

Objectives:

The student will appropriately:

1. Identify typical client signs and symptoms associated with various vestibular health conditions, including benign paroxysmal positional vertigo (BPPV), vestibular hypofunction, and central vestibular disorders.

2. Select and perform basic screening and examination tests and measures related to the vestibular system.

3. Discuss and determine the most likely diagnosis given various client scenarios.

4. Prioritize treatment interventions for a variety of clients with vestibular pathology.

5. Demonstrate treatment interventions and progressions, providing sound rationale.

For each case in the lab, relate the client’s history and presenting signs and symptoms with their vestibular condition(s), demonstrate basic cervical and oculomotor screening techniques, and explain the rationale behind interventions to treat the client’s signs and symptoms. Then, when provided with objective test results, prioritize and practice appropriate intervention ideas.

Activity 1. Benign Paroxysmal Positional Vertigo (BPPV)

Students work through case and perform specific assessments and interventions.

Activity 2. Unilateral Vestibular Hypofunction

Students work through case and perform specific assessments and interventions.

Activity 3. Central Vestibular Disorders

Students work through case and perform specific assessments and interventions.

WORKSHEET

For additional information regarding the assessments and interventions that are discussed in this lab, students are referred to the Vestibular/Cerebellar Disorders chapter in the Nichols-Larsen textbook.

Activity 1. Benign Paroxysmal Positional Vertigo (BPPV) Case Study Review

BPPV Case Study

Client is a 41-year-old woman that was referred from her family physician. She reports episodic vertigo 8 weeks in duration that began one morning while her caregiver was helping her out of bed, followed by significant nausea. Presently, she notes increased “dizziness” when rolling and transferring in/out of her wheelchair. When asked, she states that the dizziness comes on after moving and goes away after “about 1 minute or 2.” Medical history: secondary progressive multiple sclerosis, remote left tibial fracture. Fill in the table:

Screening Prior to Vestibular Testing

1. Alar-odontoid integrity test: Therapist places one hand on the occiput and uses the other hand to palpate the spinous process of C2. Flex or rotate the head to one side. Repeat on the other side. Absence of the spinous process moving to the opposite side or significant movement may indicate alar ligament laxity.

2. Sharp-Purser test: The client performs a slight cervical flexion. The therapist then places one hand on the ...