Module 6 Vestibular Issues Aural Rehabilitation

What is the difference between dizziness and vertigo

dizziness - light-headed or loss of equilibrium

vertigo - the room is spinning

________________________ can cause disequilibrium

Medication

_________________________________uses information from the vestibular labyrinth of the inner ear to generate eye movements that stabilize gaze during head movements. Without the _________________________, when walking down the street, it is impossible to read signs or even recognize faces.

Vestibular Ocular Reflex

Damage to the__________________, ________________, and ____________________ systems may impair ability to process sensory input

1. visual

2.vestibular

3. proprioceptive

List an example of damage to the

Visual system

Vestibular system

Proprioceptive system

Visual -> cataracts

Vestibular -> vestibular neuritis

Proprioceptive -> peripheral neuropathy

_______________________________________ is a very common problem and solved by a repositioning maneuver (Most common problem for the elderly)

BPPV (Benign Paroxysmal Positional Vertigo)

BPPV (benign paroxysmal positional vertigo)

balance disorder when otoliths get out of place and it causes the fluid to be displaced and go the wrong directions

What does BPPV stand for"

benign paroxysmal positional vertigo

Of the rest, those with ______________________________ or _________________________________ will respond best to therapy

1. chronic motion-provoked vertigo

2. general disequilibrium

Although stability often considered an inner ear (8th nerve) problem, it is actually an interaction between the __________________________, __________________________, and _________________________________ systems.

1. somatosensory

2. visual

3. auditory (vestibular portions)

List potential causes of vertigo (6):

1. Medication

2. Damage to the somatosensory, visual, or auditory systems

3. Insult to the CNS

4. Systemic problems

5. Neurological problems

6. Aging Issues (BPPV- most common problem of the elderly)

_____________________________ Evaluates inner ear structures, sensory and motor function of the ocular muscles, and brainstem processing

Videonystagmogram (VNG)

The Videnystagmogram (VNG) evaluates _________________, _________________________, ____________________

1. inner ear structures

2. sensory and motor function of the ocular muscles

3. brainstem processing

________________________ is a computer system designed to assess the individual and composite functioning of sensory, motor, and biomechanical components of balance

computerized dynamic posturography

___________________________________ is a computer system designed to assess the individual and composite functioning of sensory, motor, and biomechanical components of balance

computerized dynamic posturography

__________________________________________ is a form of posturography that is designed to assess quantitatively an individual's ability to use visual, proprioceptive and vestibular cues to maintain postural stability in stance

Sensory Organization Test

_________________________________________ are eye movements that you cant control. (measured when doing a videonystamogramomgram)

nystagmus

What is nystagmus?

Involuntary rapid eye movements

What causes nystagmus?

Stimulated semicircular canals when the head is not moving

Rehabilitation for vertigo is performed by _______________________________ and ____________________________________

1. audiologist

2. physical therapists

The best candidates for rehabilitation are ____________________________ and ___________________________________

1. chronic motion provoked dizziness

2. generalized disequilibrium

About _______% of vertigo in older persons is due to BPPV and is easily assisted with ___________________________________________________ performed by ___________________________

50%

repositioning maneuvers

audiologists

Improvement of balance and gait via retraining muscle responses is usually performed by the _______________________________________________________________

physical therapist

___________________________________ is a perception of sound without an external stimulus

Tinnitus

Tinnitus most often occurs with in those with ______________________________________

hearing loss

Tinnitus is usually noted in quiet and may go from _________________ to _______________________

mild to severe (in some cases tinnitus can be so severe the individual begins to have suicidal ideation)

Approximately _____- of the population has tinnitus with as many as ___________ of those over 65 reporting tinnitus.

17%

30%

Tinnitus often comes with hearing loss but additional factors may include (list 6):

1. excess cerumen

2. ototoxicity

3.Meniere's disease

4. head injury

5. aging

6. anemia

_______________________ is an abnormal condition within the labyrinth of the inner ear that can lead to a progressive loss of hearing. The symptoms are dizziness or vertigo, hearing loss, and tinnitus (ringing in the ears).

Meniere's disease

Tinnitus is typically associated with the hearing loss or trauma, researchers are now finding that tinnitus may come from the _____________________________________________________________________________ rather than the _______________________________

cortical regions of the brain

(rather than the)

cochlea

List 5 solutions performed by mental health professionals for patients with Tinnitus

1. Biofeedback

2. CBT (cognitive behavior therapy)

3. DBT (Dialectical Behavior Therapy)

4. mindfulness

5. MBTSR (mindulfness based tinnitus stress reduction)

List 6 solutions from audiologist for tinnitus:

1. Hearing Aids

2. Never be in quiet

3. Sleep Pillow system

4. tinnire device

5. Sharper Image Sound Soother Head Band

6. TRT (Tinn Retraining Therapy)

Tinnitus evaluation usually involves 7 evaluations

1. Comprehensive questionnaires (THI, TRQ, TFI)

2. Complete audiological assessment

3. Ultra high frequency testing

4. Match frequency and intensity

5. LDLs

6. Masking levels

7. Residual Inhibition

What is the current standard of care for Tinnitus?

A combination of:

1. noise therapy and 2. (CBT/DBT) mindfulness

Hull's holistic approach for AR (for adults) consists of (5):

1. Counseling

2. Hearing aid Orientation

3. Designing program for increased communicative efficiency based on individual's needs

4. Specific tx procedures that address the prioritized needs

5. Evaluation of success or lack or success in the patient's AR program

Holistic philosophy consists of (3):

1. discussion of difficulties

2. Hearing Aid orientation, ensure they are satisfied with communication in their various environments

3. Sessions that involve problem-solving and the development of communicative strategies

.What is the main type of hearing loss in adults?

Presbycusis

Presbycusis hearing loss

hearing loss that gradually occurs in most individuals as they grow older

_________________________________ involves perceptual confusions and distortions of phonetic elements of speech and amplification alone is insufficient to resolve this issue.

phonemic regression

What are the two most common rehab settings?

1. VA hospitals

2. University programs

Name other rehab settings other than VA hospitals and University programs?

1. Community centers

2. private practice audiologists

3. agencies

4. sometimes SLPs

We must learn to do more than audiometric tests and use them in conjunction with __________________. Add tests like ______________ and ____________________.

self-assessment scales

1. discrimination in noise

2. comprehension in contextualized speech

_______________________ impact the verbal forms of communication

primary effects

_____________________ effects on psycho-social, vocational, and educational issues

secondary effects

______________________ and _____________________ are discovered through self report/self assessment scales

primary and secondary effects

List the seven steps of the management process

1. Pyschosocial and counseling rehab, mutual exchange of ideas

2. Discuss problems at home, work, social settings, interpersonal comm

3. Explain the nature of HL, its consequences, and treatment

4. Develop strategies to different situations

5. Group therapy to eliminate the feeling of being different.

6. Strategies to empower and foster independence

7. Be a source of information- financial assistance, legal rights, cochlear implants, etc.

__________________________________ is a model that encourages family and caregivers to use independence-supporting behaviors

The Communication Enhancement Model

When planning management, you may want to fill in 3 things... list them:

1. Initial complaint

2. Objectives for end of the 3rd week of trial period

3. Action

What are the three objectives in a management plan?

1. Audibility objectives

2. Activity objectives

3. Participation objectives

What type of self-efficacy strategy are these?:

- practice or role play

- Break complex behavior into sub-behaviors

- Grade difficulty of tasks from easy to hard

Mastery Experience Strategies

What type of self-efficacy strategy are these?:

-Teach skills to significant other

-Watch others role play in a group

-Videotape a peer model performing a behavior

Vicarious Experience

What type of self-efficacy strategy are these?:

-Give appropriate feedback

-Recruit social support

-Provide training materials with explanations using pictures

Psychological and emotional states

List the four types of self-efficacy strategies?

1. Mastery Experience

2. Vicarious Experience

3. Verbal Persuasion

4. Psychological and emotional states

What are the four main pyschological impacts of HL?

1. Insecurity

2. Annoyance

3. Localization

4. Loss of esthetic experiences

What type of counseling is being described here?:

-Help the patient accept the reality of HL

-Help them admit to needing help

-Help them modify maladaptive attitudes about themselves

Personal adjustment counseling

What type of component of personal adjustment counseling is being described?:

-Understand the real feelings causing the statements patients say.

-Reflect them back and get them to look at the problem objectively

Acurate Empathy

What type of component of personal adjustment counseling is being described?:

- Accept the patient as they are regardless of bad attitude.

-Look at their experience through their eyes.

Unconditional Positive Regard

What type of component of personal adjustment counseling is being described?:

-Emit a relaxed, friendly attitude to the patient

-Respect for their ideas, accept their criticism, and communicate with the patient in away they can easily understand

Genuiness

Name they type of counseling being described here:

-Give information about HL and its effects

-Give information about intervention procedures

-Recommend group therapy, etc

Educational or Informational counseling

What are 5 components of educational counseling?

1. Have planned topics

2. Identify difficult listening situations

3. Assertiveness training

4. Anticipatory strategies

5. Educating Significant Others

What are 3 aspects of the counseling process?

1. the counselor: mental health, vocational, AR focused

2. Inter-professional coordination: audiologist with basic skills in counseling, psychologist

3. The counseling process: a) preferred mode of comm., concrete vs abstract, general info gaps (understand they may not know things due to lack of incidental learning), knowledge of services and agencies

What are here-and-now strategies?

-Created by English

-Counseling that focuses on supporting individual's adjustment to current issues by helping them understand their feelings and learn to problem-solve

True or False: counseling is the same as psychotherapy.

FALSE

Clinicians generally provide three types of counseling... list them:

1. Informational counseling

2. Rational acceptance and adjustment counseling

3. Emotional acceptance and adjustment counseling

Rational acceptance and adjustment as well as emotional acceptance and adjustment counseling are typically considered under the umbrella term: _________________________________________

Personal adjustment counseling

Counseling should involve these 7 steps:

1. help patients tell their own story

2. help patients clarify their problems

3. help patients take responsibility for their listening problems (challenge themselves)

4. help patients establish their goals

5. develop an action plan

6. implement the plan

7. conduct ongoing evaluation

What are 7 important elements of AR services according to Hull?:

1. Counseling

2. Hearing Aid orientation

3. Adjusting the listening environment

4. Develop positive assertiveness

5. Develop compensatory skills

6. Develop strategies for manipulating the communicative environment to one's advantage

7. Involving family and significant others

microbes (2 types)

1. pathogenic: naturally cause disease (HIV, Hep B, TB)

2. opportunistic: normally harmless, live on us, cause disease only if there is immunodeficiency, harmful if given opportunity

modes of transmission (4)

1. contact: direct, indirect, droplets

2. vehicle: food, water, blood, body substance

3. airborne: air

4. vectorborne: insect or animal

route: how it enters, body openings, eyes, ear, nose, mouth

will invader get u? that depends on…

1. virulence: how quick the body IDs and attacks the invading microbe (NO Control)

2. titer number: number of organisms that entered (Almost all control)

3. resistance of host (some control, take care of yourself)

infection control program is

an organized effort to manage one’s environment to minimize exposure to pathogenic microbes

basic tenets of infection control (2) 3 and 4

1. Environment: 1) Clean: remove gross contamination, visible dirt/soil 2) Disinfect: kill specific number of germs (household to hospital grade) spray, wipes, soaking. 3) Sterilize: kill 100% of germs, kill both vegetative state of germ and spore form

2. Human: 1) hand, Gloves, Eyes/mouth/nose, medical history

ways to sterilize (3)

i. autoclave: heat or pressure

ii. chemclave: chamber for things that can melt, chem bath and gas

iii. gluteraldehyde: cold sterilization, 2% concentration, toxic, carcinogen

two step process of hygiene

1. clean 2. disinfect

Clinicians generally provide 3 types of counseling:

1. Informational — Explain HL, audiogram, tech.

2. Rational — Teach strategies, ALDs.

3. Emotional — Address feelings, self-image.