CVT Vestibular Rehabilitation Techniques 3 — Questions and Answers
Question 1: A therapist prescribes VOR x2 exercises. How does this differ mechanically from VOR x1?
- The target moves in the same direction as the head at double speed (Correct answer)
- The target moves opposite to the head at double the head velocity
- The patient moves the head twice as fast with the target stationary
- The patient uses two targets simultaneously
Correct answer: The target moves in the same direction as the head at double speed
In VOR x2, the target moves in the same direction as the head, requiring the VOR to generate twice the normal gain to maintain stable gaze.
Question 2: Which parameter should be GRADUALLY increased when progressing gaze stabilization exercises to avoid over-provoking symptoms?
- Target color contrast
- Head movement velocity and frequency (Correct answer)
- Room lighting
- Number of targets
Correct answer: Head movement velocity and frequency
Progressive increases in head velocity and frequency challenge the VOR incrementally without causing symptom exacerbation that could limit participation.
Question 3: The Fukuda stepping test assesses which vestibular function?
- Utricular otolith function during vertical acceleration
- Asymmetry of vestibulo-spinal reflexes by measuring body rotation during stepping in place with eyes closed (Correct answer)
- Horizontal VOR gain at high frequencies
- Saccular function during sound stimulation
Correct answer: Asymmetry of vestibulo-spinal reflexes by measuring body rotation during stepping in place with eyes closed
The Fukuda stepping test detects vestibulo-spinal asymmetry; patients with unilateral hypofunction rotate toward the lesion side when stepping in place blindfolded.
Question 4: What is the primary reason a CVT should avoid prescribing canalith repositioning maneuvers for a patient with a perilymph fistula?
- Maneuvers are ineffective for BPPV in this population
- Positional changes may worsen the fistula and increase symptoms (Correct answer)
- The vestibular nerve is unaffected in perilymph fistula
- Canalith repositioning requires intact utricle function
Correct answer: Positional changes may worsen the fistula and increase symptoms
Perilymph fistulas involve a tear in the oval or round window membranes, and aggressive positional maneuvers can exacerbate the leak and symptoms.
Question 5: Which functional balance task BEST challenges the vestibulospinal reflex in a community-ambulatory vestibular patient?
- Seated trunk stability exercises
- Tandem gait with head turns on an uneven surface (Correct answer)
- Supine lower extremity strengthening
- Stationary standing on firm surface with eyes open
Correct answer: Tandem gait with head turns on an uneven surface
Tandem gait with simultaneous head turns on an uneven surface integrates vestibulospinal demands with reduced base of support and somatosensory perturbation.
Question 6: In vestibular rehabilitation, what does the term 'compensation' refer to?
- Full recovery of labyrinthine hair cell function
- CNS neuroplastic adaptation that reduces symptoms despite a persistent peripheral deficit (Correct answer)
- Pharmacological suppression of vestibular symptoms
- Surgical correction of semicircular canal pathology
Correct answer: CNS neuroplastic adaptation that reduces symptoms despite a persistent peripheral deficit
Vestibular compensation is the CNS process by which the brain rebalances tonic firing rates and incorporates alternative sensory inputs to reduce symptoms from a peripheral lesion.
Question 7: A patient reports worsening symptoms when walking through a busy grocery store. Which rehabilitation approach BEST addresses this visual motion sensitivity?
- Canal repositioning maneuvers
- Optokinetic stimulation exercises with progressively complex visual environments (Correct answer)
- Vestibular suppressant medications
- Strengthening lower extremity musculature
Correct answer: Optokinetic stimulation exercises with progressively complex visual environments
Optokinetic exercises expose patients to moving visual fields to desensitize the CNS to visual-vestibular conflict, directly targeting supermarket-type environments.
CVT Vestibular Rehabilitation Techniques 3
A therapist prescribes VOR x2 exercises.
How does this differ mechanically from VOR x1?