Vestibular Rehabilitation facilitates improvements in readi - PowerPoint Presentation

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Vestibular Rehabilitation facilitates improvements in reading and visual deficits post mild traumatic brain injury: A case study.By Karen Stevens, Hallamshire Physiotherapy Clinic, Sheffield.

Case history:A 21 year old male student was referred for Vestibular Rehabilitation (VR) after sustaining localised brainstem damage during a professional kick boxing match three years prior.Presented with vertigo with fast head movements, visual difficulties when switching from near to far visual tasks (e.g. in lectures), problems visually tracking objects (e.g. playing football), poor concentration especially when reading, and motion sensitivity.Minimal anxiety related to his symptoms was detected. Some avoidant behaviour was identified.  He engaged with the majority of functional activities and had implemented some useful strategies to cope with his deficits.

Treatment choices:Goal = Improve visual tracking and stability. Goal = To reduce motion sensitivity Gaze Stabilisation exercises:X1/X2 viewingEye-head to target Initially in sitting then standing.1 minute each exercise, 4-5 times per dayProgressions:Increasing distance from targetReducing base of supportUnstable baseTarget placed on a visually busy background e.g. windowDual task e.g. counting backwards 4 treatment sessions over three month period

Optokinetic Stimulation video

Watching in sitting progressed to more challenging balance positions.

Outcomes:

Vestibular Rehab Benefits questionnaire (VRBQ):

VRBQ(Morris et al 2009) Head thrust test no longer positive

https://www.youtube.com/watch?v=kAPtu1WTHYc

Literature review:

Several studies support the use of VRT in mild TBI (Gurley et al 2013, Gottshall 2011, Gurr et al 2001). Descriptive studies.Support for customized VRT with specialised staff (Aligene et al 2013, Gurley et al 2013)Need to consider all potential consequences of mild TBI (Gottshall 2011) Useful article (Cohen 2013) reviewing role of Neuro-optometrist in visual-vestibular dysfunction.

Reflection:VRBQ helped to focus the VRT program and drew attention to areas such as activity avoidance that the client did not openly report.YouTube video added a different dimension to home exercise program and helped motivation.Use of a specific reading outcome measure could have been useful - ? Any standardized measures, ? Timed section of text

ConclusionAlthough functioning at a high level with self generated coping strategies, the client benefitted from VRT. He made quick gains requiring a low number of sessions. The literature suggest VRT is beneficial in MTBI and this case study supports this.

References:Aligene, K. and Lin, E. (2013) Vestibular and balance treatment of the concussed athlete. Neurorehabilitation 32 543-553  Gottshall,K. (2011) Vestibular rehabilitation after mild traumatic brain injury with vestibular pathology. 29 167-171Gurr, B. and Moffat, N. (2001)  Psychological consequences of vertigo and the effectiveness of vestibular rehabilitation for brain injury patients. Brain injury 15(5) 387-400Morris, A. Lutman, M. Yardley, L. (2009) Measuring outcome from vestibular rehabilitation, part ii: refinement and validation of a new self-report measure. International Journal of Audiology 48: 24-37

Subjective changes:Able to text and walk concurrentlyAble to sit towards the back of the lecture theatreCan concentrate for longer on readingObjective markers post treatment:Smooth pursuit normalTimed unsupported stand feet together with eyesincreased from 10 seconds to 45 secondsFudeka’s stepping test – returned to normalHead thrust no longer positive

Key: Blue = pre-treatment Yellow = post treatment

VBRQ is a self

reported outcome

measure. It includes

symptoms and

quality

of life subscales. Threshold for clinically meaningful

change are available

.