Concussion Treatment
Original Editor - Megyn Robertson
Top Contributors - Simisola Ajeyalemi, Kim Jackson, Mandy Roscher, Megyn Robertson, Robin Tacchetti, Samuel Adedigba, Rachael Lowe, Jess Bell, Olajumoke Ogunleye and Nupur Smit Shah
Using Vestibular/Ocular-Motor Screening (VOMS)as Treatment[edit | edit source]
Exercise approaches to alleviate symptoms of vestibular hypofunction can be divided into two categories – namely adaptation or habituation exercises.
Habituation[edit | edit source]
Habituation exercises are given to patients who have certain types of inner ear disorders such as dizziness when they move their heads in certain ways. Habituation exercises are based on the idea that repeated exposure to a provocative stimulus (e.g. head movements) will lead to a reduction of the motion-provoked symptoms.[1][2] This change is thought to be due to long-term changes within the nervous system, and there is clinical evidence indicating that the habituation exercises can lead to long-term changes in symptoms.[3]The actual neural mechanism behind the effectiveness of the habituation exercises is not understood.
Adaptation[edit | edit source]
Adaptation exercises or gaze stability exercises are used to modify the magnitude of the vestibulo-ocular reflex (VOR) in response to a given input (head movement). One of the signals that induces adaptation of the VOR is retinal slip combined with head movement.[4]. This is the basis for what has traditionally been considered adaptation exercises. These exercises require the individual to perform rapid, active head rotations while watching a visual target, with the stipulation that the target remains in focus during the head movements.[5]If the target is stationary, then the exercises are referred to as x1 viewing exercises. If the target is moving in the opposite direction of the head movement, then these exercises are referred to as x2 viewing exercises. While these exercises have been shown to improve dynamic visual acuity, the actual mechanism behind this improvement is not known.[6]
Patients who perform gaze stability exercises will improve their dynamic visual acuity. Patients who perform habituation exercises will have a greater reduction in their motion sensitivity. Both exercise interventions lead to a reduction in the self-report measure of the impact of symptoms on the ability to function, a decrease in the sensitivity to movements, and an improvement in the ability to see clearly during head movements.
VOMS Treatment[edit | edit source]
In a nutshell, take what hurts or exacerbates patient symptoms and use that as your rehabilitation programme. Ease the patient into it, using graded exposure, until the patient is able to perform the activity without symptom exacerbation. I generally incorporate both habituation and adaptation in my regimes. Clendaniel[7] outlines an example of a home programme below with progressions. I like to change the base of support and surfaces (stable to unstable) in conjunction with my VOMS progressions. You can also change the environment from quiet and low light to noisy and bright light as the patient tolerates for additional sensory load/input.
Exercise Progression[7]
| Gaze-Stabilization Exercises | Week | Habituation Exercises |
|---|---|---|
| Horizontal and vertical x1 viewing exercise with near target, 1 minute duration, sitting | 1 | Large amplitude, rapid cervical rotation (horizontal or vertical), each set of exercise consisted of 5 complete movements (cycles) and the individual performed 3 sets, sitting |
| Horizontal and vertical x1 viewing exercise with near target, 2 minute duration, sitting | 2 | Large amplitude, rapid horizontal cervical
rotation (seated) and standing pivots, or large amplitude, rapid vertical cervical rotation (seated) and seated trunk flexion-extension, 3 sets of 5 cycles |
| Horizontal and vertical x1 viewing exercise with near and far targets, 2 minute duration, standing | 3 | Large amplitude, rapid horizontal and vertical cervical rotation (seated) and standing pivots, or large amplitude, rapid horizontal and vertical cervical rotation (seated) and seated trunk flexion-extension,3 sets of 5 cycles |
| Horizontal and vertical x1 viewing exercise with near and far targets, and targets located in front of a busy background, 2 minute duration, standing | 4 | Large amplitude, rapid horizontal and vertical cervical rotation (seated), standing
pivots, and seated trunk flexion-extension, 3 sets of 5 cycles |
| Horizontal and vertical x1 viewing exercise with near and far targets, and targets located in front of a busy background. Horizontal and vertical x2 viewing exercise, plain background. All exercises 2 minute duration, standing | 5 | Large amplitude, rapid horizontal and vertical cervical rotation (standing), standing pivots, and seated trunk flexion-extension,3 sets of 5 cycles |
| Horizontal and vertical x1 viewing exercise with near and far targets, and targets located in front of a busy background. Horizontal and vertical x2 viewing exercise, busy background. All exercises 2 minute duration, standing | 6 | Large amplitude, rapid horizontal and vertical cervical rotation (standing), standing pivots (180 degrees), seated trunk flexion-extension, and Brandt- Daroff exercise 3 sets of 5 cycles |
Sub Heading 3[edit | edit source]
Resources[edit | edit source]
References[edit | edit source]
- ↑ Shepard NT, Telian SA, Smith-Wheelock M, Raj A. Vestibular and balance rehabilitation therapy. Annals of Otology, Rhinology & Laryngology 1993;102(3 Pt 1):198–205.
- ↑ Telian SA, Shepard NT, Smith-Wheelock M, Kemink JL. Habituation therapy for chronic vestibular dysfunction: preliminary results. Otolaryngol Head Neck Surg. 1990;103(1):89–95.
- ↑ Clement G, Tilikete C, Courjon JH. Retention of habituation of vestibulo-ocular reflex and sensation of rotation in humans. Exp Brain Res 2008 Sep;190(3):307–315.
- ↑ Shelhamer M, Tiliket C, Roberts D, Kramer PD, Zee DS. Short-term vestibulo-ocular reflex adaptation in humans. II. Error signals. Exp Brain Res. 1994;100(2):328–336.
- ↑ Herdman SJ. Exercise strategies for vestibular disorders. Ear Nose Throat J 1989;68(12):961–964.
- ↑ Herdman SJ, Schubert MC, Das VE, Tusa RJ. Recovery of dynamic visual acuity in unilateral vestibular hypofunction. Arch.Otolaryngol Head Neck Surg 2003;129(8):819–824.
- ↑ 7.0 7.1 Clendaniel RA . The effects of habituation and gaze-stability exercises in the treatment of unilateral vestibular hypofunction – preliminary results. J Neurol Phys Ther. 2010;34(2): 111–116.
