presented by Tracy Stackhouse
This course provides the fundamentals for understanding how to harness the power of the vestibular system to influence optimal outcomes when vestibular-based intervention is indicated. A basic overview of vestibular function and anatomy, as well as central nervous system interaction is provided. Vestibular functions will be traced from the receptor through the primary and associated processing pathways. The content will include information on how to directly assess vestibular function as well as the common physiological, postural, ocular manifestations that need to be included in assessment. Vestibular processing is a quiet, pivotal foundation, critical in the ASI approach, and often a missing link underlying neurodevelopmental progress. Treatment considerations to produce effective improvements in specific vestibular symptoms (dizziness, motion perception difficulties) as well as the direct products of vestibular processing, (balance, bilateral coordination, postural/ocular control, motor timing and coordination, visual motor/perceptual skills, etc) are provided. These considerations are extended to include associated modulation-based difficulties, including a grounded sense of self within the context of person/environment/other/task, and as functional abilities related to vestibular processing are provided.
Tracy Stackhouse is a clinical pediatric occupational therapist who has specialized in working with children, adults, and families affected by fragile x syndrome (FXS) and Fragile X related conditions since the late 1980s. Through this work, first at Children's Hospital in Denver, continuing at the UC Davis MIND Institute, and now at the nonprofit center she co-founded (Developmental FX), she has been able to provide continuity of care with hundreds of families affected by FXS. This allows her to offer a perspective to the families she serves and the colleagues with whom she collaborates about how FXS looks neurodevelopmentally. Tracy is committed to conducting research to advance the understanding and treatment of neurodevelopmental disabilities and FXS specifically. She is the director of the Developmental & Fragile X Resource Centre in Denver, CO, which is included as a part of the Denver Fragile X Clinic of the Fragile X Clinics and Research Consortium (FXCRC). She has been involved in fragile X clinical care and research since 1989 and has been involved with the National Fragile X Foundation (NFXF) since 1989, including active contribution to clinical materials and general advice. Tracy is a member of the Clinical Research Consortium of the NFXF, as well as a member of the Scientific and Clinical Advisory Committee. In 2013, she served as a consultant to Novartis during their clinical trial for a targeted treatment in FXS. Recently, she has been involved in the efforts to identify feasible and reliable neuromotor outcome measures that can be used in clinical trials. This project resulted in development of the FX Motor Battery, which is proposed to be further piloted in this study. Tracy is committed to the success of the proposed project and has a history of collaborative work with this research team that will support this project’s success.
The focus of this training is to deepen understanding of the vestibular system, a system so mighty that it is at the crux of understanding ourselves and the world around us. This chapter introduces what will be covered, identifying the frame of reference (ASI) as well as general terminology. The review will include the functional neuroanatomy and how the sensory information is integrated into key adaptive functions including postural control, motion, equilibrium, spatial orientation, and arousal modulation The course will include general information for assessment and treatment planning. This topic is important for pediatric OTs, as vestibular processing, together with the somatosensory system, form the focal foundation for Ayres' Sensory Integration (ASI) Theory.
This chapter provides detailed information about the location, structure, and function of the vestibular apparatus. The vestibular labyrinth includes semicircular canals and macular receptors, the utricle and saccule. The location in the inner ear, the bilateral partnering of the right and left labyrinthine structures, and their relative position in the head are reviewed so that the information received by these structures can be visualized for enhanced clinical reasoning in a vestibular-based intervention approach.
Vestibular information is carried via the eighth cranial nerve through central vestibular pathways. The organization of the pathways as they move into the brainstem and then share information across the CNS is presented such that the structure/function relationships are more apparent. This allows the clinician to visualize receptors through pathways to adapt function and increase precision in clinical reasoning for enhanced treatment planning.
The vestibular system is mighty, in part because it is structurally and functionally integrated into such a wide range of adaptive functions. This chapter reviews the sensory modulation and sensory discrimination aspects of vestibular contributions to postural/ocular functions, body control, gravity management, balance, and equilibrium, laterality, coordination, spatial, and temporal processing, problem solving, executive functions, social cognition, stability of self, affect/arousal/attention/action regulation systems, and emotional regulation. This range of adaptive capacities ties to Ayres’ theory of vestibular integration being necessary for daily occupational performance and that when difficulties arise, identifying how the vestibular function may be involved allows for proper treatment.
A general idea of basic postural, ocular, balance, spatial, and timing aspects of vestibular integration and how they can be addressed in formal assessments, clinical observations, and within treatment for increasing power and precision and maximizing outcomes is provided in this final chapter.