[Kyle Reedy]

Thank you Chrissy. I think this is a good dive into the articles. I appreciate you looking into those and synthesizing the information. I like the recommendation of tie back to function at the end. some people may need that long duration at slower speeds

[Kyle Reedy]

I have not taken the NCS so i cannot attest to the questions. However, what i do think is important for this test is that they always want to know application, more so correct application. So i do think it makes sense for them to ask the correct head rotation for tests to ensure you are doing a correct R vs L Gufani. Especially the starting positions.

In practice, i use a gufani instead of a BBQ roll. More so, the gufani can be reverse for a cupulithiasis vs a canalithiasis. An example is how you look at the bow and lean test to diagnose the effected ear for a HoSCC canal/cupulolithiasis.

So application:
If i were to be treat a L horizontal canal canalithiasis. I can treat with a L gufoni. This requires me to to the patient in contralateral sidelying (R), then rotate to the ground (contra rotation) (R), then rise to sitting.
also a tip, a goal for cupulo is to convert it to canal then treat it like a canal.

lastly. gufoni=appiani

[Kyle Reedy]

Hi Jackie, good question.

Most of the vestibular patients i treat are concussion patients with a splash of chronic hypofunction. For these, I go by the vestibular rehab hypofunction guidelines in regard to volume of exercise. What i find more important than anything inregard to vestibular rehab interventions is the intensity. Symptoms should be increased with VOR exercises however should not be unbearable. whether this by symptom onset or gaze instability. For symptoms, their symptoms can increase by 1-2 above baseline and should subside after resolution of exercise and if they have any prolonged symptoms, it should be better <15min of resolution of total exercise. In regard to volume of exercise, i follow the CPG “Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-Based Clinical Practice Guideline” Home Exercise Program:
— Acute: > 3x/day for > 12 minutes total
— Chronic: >3x/day for > 20 minutes total

i break these exercises into 2-3 bouts. acute i give them 3x/day for 5-10min each.

For specific articles, i do not have ready to cite. They are based off the Medbridge courses i have taken as well as the recommendations from co-workers.

To be more specific with your question i pose 2 thoughts here that i do and do not agree with. First the frequency: 2mHz would be 120bpm. However the VOMS tests the VORx1 at 180bpm. So this study may not be getting the right intensity of what is considered normal. This could be due to decreased rate for increased time. I have personally favored increased rates over decreased time (focussing on 180bpm for 20sec at at time) given this is very flexible with patient presentation. My second thought is a personal opinion, is i do not find 2min of straight VOR to be function. VOR is not an enduruance reflex, it is a quick compensation reflex. So i would not do this for 2min.

I kind of went off on tangents. But thought this was good discussion question so i wanted to join in.

[Kyle Reedy]

Hello, I will explain my rationale for this one.

In conditions 1-3 somatosensory is pereserved and in result we have no falls. In conditions 4-6, we impair the somatosensory and start to cause falls. despite the other inputs. For proper balance we need 2/3 of the balance inputs. This patient only preserves his balance with accurate input form the somatosensory system (not on compliant surface)

Condition 1: all 3 are used (somat, visual, vestib) balance is preserveed
Condition 2: somat and vestib are used and balance is preserved
condition 3: somat and visual are used and balance is preserved
condition 4: visual and vestib are used and balance is LOST
condition 5: vestib only and balance is LOST
condition 6: visual only and balance is LOST.

so what we are seeing here is presentation of patient that is somatosensory dependent (must have accurate somatosensory cues) for balance and has some degree of impairment with the visual and vestibular systems for balance.

hope this helps

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