Visually Induced Dizziness

Q: What is the application difference between the narrower tape vs wider tape for binocular occlusion?


Answer:

“The literature shows after a brain injury, using binocular occlusion can help cause a visual frame of reference. And so the patient is still able to utilize their full visual field, but they have small pieces of tape here that are able to anchor their vision, essentially. And so typically with those patients, and this is in concordance with a neuro optometrist or ophthalmologist, those are going to be smaller.

For what we use in outpatient, and again, these aren’t necessarily patients that have an acquired brain injury, these are patients that have peripheral vestibular disorders and also have motion sensitivity, we’ll use the nasal occlusion a little bit thicker almost to impair some of their central vision. And the reason why is because you really want to encourage central peripheral integration. And a lot of our patients with dizziness become very centrally bound. When you feel dizzy, or when you feel fearful of falling, you start focusing on a really small area and you can even see some postural changes. And so by temporarily occluding some of the central vision, of course you don’t want to cover their whole glasses, you’re kind of encouraging them to use more of that peripheral information for where they are in space, which is also going to habituate them.

And so the way that we, there was a question earlier about how do we know to use that, sometimes we’ll simply put a pair of glasses on the patient and have repeat an exercise that didn’t give them any symptoms and see if it changes. See if it causes more symptoms now that they’re utilizing the peripheral vision.

So hopefully that makes it clear on how the two different things are used. One is used as a visual anchor for acquired brain injury, and that’s when you’re working with a neuro optometrist or a neuro ophthalmologist. And then the other is more of a way to open the patient’s field of vision and utilize peripheral and central integration.”

Faculty:

Kendal Reddell, PT, DPT, NCS & Alex Tarabbia, PT, DPT

Q: What are two different criteria you’re observing during VOR cancellation also known as the motion sensitivity test?


Answer:

“So the tests that we referred to today is the one where you have your thumbs out and you’re swinging back and forth. And typically with that test, you’re looking for motion sensitivity. With the other version of the test, what I’ll do is I’ll hold the patient’s head. I don’t know if you can see my hands. Let me back up a little bit. I’ll hold the patient’s head and I’ll have them focus on my nose, and I’ll move back and forth. So you’re doing the same thing, except in that one, I’m actually looking at their eyes to see if they’re having saccadic catch-ups, and that would be a central sign. So you can look at two different things with this test. You can look at motion sensitivity, which is going to happen in some of your peripheral impaired patients who don’t necessarily have any central issues. Then when you’re looking at the patient’s eyes and you see those corrective saccades, that is a central sign. So hopefully that clarifies it a little bit. You can look at two separate things using the same test.”

Faculty:

Kendal Reddell, PT, DPT, NCS & Alex Tarabbia, PT, DPT

Q: What do you recommend when using optokinetic stimulation in an acquired brain injury population with seizure precautions?


Answer:

“When I utilize optokinetic stimulation, whether it be striped or checkered paper, or utilizing any kind of screens, I typically get MD clearance. I look at the full medical history, whether they’re on seizure medications, if they’ve had a past history of seizures, and usually that’s not one of the first things that I go to. So what I’ll do is start typically with just true motion because a lot of our acquired brain injuries, whether it be acute or chronic will have true motion sensitivity in addition to visual motion sensitivity, and so I just want to say thank you because that really is a concern, is you don’t want to trigger a seizure. You don’t want to make the patient worse, but you also want to address their deficits. There was some good information about less than three Hertz being at a lower risk for the speed of the optokinetic stripes versus greater than three Hertz. So hopefully, that was a good answer to your question.”

Faculty:

Kendal Reddell, PT, DPT, NCS & Alex Tarabbia, PT, DPT

Q: What is Box Breathing?


Answer:

“Box breathing is a sympathetic de-stimulation exercise. And so, basically, we have a sheet of paper and we also have an app that can be on a computer screen that forms a box. So they’ll breathe in for four seconds on this part of the box, hold their breath for four seconds, breathe out for four seconds, and hold their breath for four seconds. And so it’s a way for patients to reduce that sympathetic response, to ground a little bit, and it can really help with self-awareness and calming their symptoms, especially when there’s that anxiety component.”

Faculty:

Kendal Reddell, PT, DPT, NCS & Alex Tarabbia, PT, DPT



RESOURCES & LINKS:



FACULTY BIOs:

Kendal Reddell, PT, DPT, NCS

​Kendal Reddell has a doctorate in physical therapy and is an American Physical Therapy Association Board Certified Clinical Neurologic Specialist. She also holds a certificate of competency in the evaluation and treatment of vestibular disorders from Emory University. Kendal is a Parkinson’s Wellness Recovery (PWR!) and LSVT BIG certified therapist, specializing in treating individuals with Parkinson’s disease. Dr. Reddell is a proud graduate of Tarleton State University where she competed in NCAA Women’s Basketball. She received her Doctorate in Physical Therapy from the University of Texas Southwestern Medical School in 2010, and has worked in a variety of settings specializing in brain injury, stroke, Parkinson’s Disease, and vestibular disorders.

Alex Tarabbia, PT, DPT

Alex Tarabbia has a Doctorate in Physical Therapy. She developed a passion for vestibular therapy when volunteering at a specialty balance clinic in her college years. This passion grew while working with patients with vestibular disorders through graduate level clinical internships, as well as taking advanced coursework in vestibular therapy in graduate school. Prior to joining the 360 Balance & Hearing team, Dr. Tarabbia worked with patients with a variety of orthopedic injuries and balance and mobility impairments in the outpatient setting. Dr. Tarabbia completed her undergraduate work at Gordon College, in Massachusetts, graduating Summa Cum Laude with a Bachelor’s degree in Kinesiology. She received her Doctorate in Physical Therapy from the University of St. Augustine, in Austin, Texas.